Provider Demographics
NPI:1407171812
Name:PENTECOSTES, ELSA
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:PENTECOSTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5058 BRYN MAWR CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4722
Mailing Address - Country:US
Mailing Address - Phone:907-766-2645
Mailing Address - Fax:
Practice Address - Street 1:5058 BRYN MAWR CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4722
Practice Address - Country:US
Practice Address - Phone:907-766-2645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-30
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility