Provider Demographics
NPI:1457474561
Name:FLAMINGO HOUSE
Entity Type:Organization
Organization Name:FLAMINGO HOUSE
Other - Org Name:MARGARET WILLIAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:VALERIE
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:PCA
Authorized Official - Phone:907-222-6899
Mailing Address - Street 1:3705 ARCTIC BLVD ANCHORAGE ALASKA 99503
Mailing Address - Street 2:8611 FLAMINGO DRIVE
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502
Mailing Address - Country:US
Mailing Address - Phone:907-222-1675
Mailing Address - Fax:907-222-4830
Practice Address - Street 1:3705 ARCTIC BLVD # 1211
Practice Address - Street 2:7711 ARLENE STREET #A
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5774
Practice Address - Country:US
Practice Address - Phone:907-222-6899
Practice Address - Fax:907-222-6899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3104A0625X
AK1003773104A0630X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL97681Medicaid
AKHC97681Medicaid