Provider Demographics
NPI:1407442650
Name:CLOUDBERRY CARE CLINIC LLC
Entity Type:Organization
Organization Name:CLOUDBERRY CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. SARA LINDSOE/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDSOE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:907-980-5981
Mailing Address - Street 1:PO BOX 231829
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-1829
Mailing Address - Country:US
Mailing Address - Phone:907-980-5981
Mailing Address - Fax:
Practice Address - Street 1:8136 WHITE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-6046
Practice Address - Country:US
Practice Address - Phone:907-980-5981
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-11
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1691022Medicaid
AK136171OtherALASKA APRN LICENSE