Provider Demographics
NPI:1225228414
Name:C CARE SERVICES, LLC
Entity Type:Organization
Organization Name:C CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-830-0518
Mailing Address - Street 1:991 S HERMON RD
Mailing Address - Street 2:SUITE 400 A
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7312
Mailing Address - Country:US
Mailing Address - Phone:907-830-0518
Mailing Address - Fax:907-563-5047
Practice Address - Street 1:991 S HERMON RD
Practice Address - Street 2:SUITE 400 A
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7312
Practice Address - Country:US
Practice Address - Phone:907-830-0518
Practice Address - Fax:907-563-5047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK436948251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPCG 291Medicaid