Provider Demographics
NPI:1407096878
Name:CONSUMER CARE NETWORK INC
Entity Type:Organization
Organization Name:CONSUMER CARE NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:OGBOUMA
Authorized Official - Middle Name:OKE
Authorized Official - Last Name:ULOFOSHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-334-3050
Mailing Address - Street 1:440 W BENSON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3860
Mailing Address - Country:US
Mailing Address - Phone:907-334-3050
Mailing Address - Fax:907-334-3058
Practice Address - Street 1:440 W BENSON BLVD STE 101
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3860
Practice Address - Country:US
Practice Address - Phone:907-334-3050
Practice Address - Fax:907-334-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK433132251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC03592Medicaid
AKHC03591Medicaid