Provider Demographics
NPI:1235353822
Name:SENIOR QUALITY CARE, INC.
Entity Type:Organization
Organization Name:SENIOR QUALITY CARE, INC.
Other - Org Name:SUMMER SHADES RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOD
Authorized Official - Middle Name:R
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-378-2309
Mailing Address - Street 1:319 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5029
Mailing Address - Country:US
Mailing Address - Phone:907-456-5909
Mailing Address - Fax:907-456-2652
Practice Address - Street 1:319 6TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5029
Practice Address - Country:US
Practice Address - Phone:907-456-5909
Practice Address - Fax:907-456-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000021310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL8363Medicaid