Provider Demographics
NPI:1275718769
Name:MAT-SU VALLEY II LLC
Entity Type:Organization
Organization Name:MAT-SU VALLEY II LLC
Other - Org Name:MAT SU REGIONAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:950 E BOGARD RD
Mailing Address - Street 2:SUITE 132
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:950 E BOGARD RD
Practice Address - Street 2:SUITE 132
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7105
Practice Address - Country:US
Practice Address - Phone:907-861-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-03
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK297764251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK027008Medicare Oscar/Certification