Provider Demographics
NPI:1164019329
Name:GREENWOOD CARE SERVICES, LLC
Entity Type:Organization
Organization Name:GREENWOOD CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:LIZALDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-646-2273
Mailing Address - Street 1:8100 GREENWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3318
Mailing Address - Country:US
Mailing Address - Phone:907-646-2273
Mailing Address - Fax:907-865-5956
Practice Address - Street 1:8100 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-3318
Practice Address - Country:US
Practice Address - Phone:907-646-2273
Practice Address - Fax:907-865-5956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1602351Medicaid
AK1629621Medicaid