Provider Demographics
NPI:1477152148
Name:GLACIER CARE TRANSIT SERVICES LLC
Entity Type:Organization
Organization Name:GLACIER CARE TRANSIT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:N
Authorized Official - Last Name:ACHAKENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-231-0030
Mailing Address - Street 1:3111 E 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2070
Mailing Address - Country:US
Mailing Address - Phone:907-231-0030
Mailing Address - Fax:907-308-6977
Practice Address - Street 1:3111 E 64TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2070
Practice Address - Country:US
Practice Address - Phone:907-231-0030
Practice Address - Fax:907-308-6977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1708774.Medicaid
AK1709412Medicaid