Provider Demographics
NPI:1295043339
Name:HOMEWELL SENIOR CARE
Entity Type:Organization
Organization Name:HOMEWELL SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FROMMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-868-3100
Mailing Address - Street 1:1801 E DOWLING RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1918
Mailing Address - Country:US
Mailing Address - Phone:907-868-3100
Mailing Address - Fax:907-868-4658
Practice Address - Street 1:1801 E DOWLING RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1918
Practice Address - Country:US
Practice Address - Phone:907-868-3100
Practice Address - Fax:907-868-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-23
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG107Medicaid