Provider Demographics
NPI:1497932420
Name:VALDEZ SENIOR CITIZENS
Entity Type:Organization
Organization Name:VALDEZ SENIOR CITIZENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:G
Authorized Official - Last Name:KEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-835-5032
Mailing Address - Street 1:PO BOX 1635
Mailing Address - Street 2:
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686-1635
Mailing Address - Country:US
Mailing Address - Phone:907-835-5032
Mailing Address - Fax:907-835-2518
Practice Address - Street 1:1300 E HANAGITA PLACE
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686-1635
Practice Address - Country:US
Practice Address - Phone:907-835-5032
Practice Address - Fax:907-835-5032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG008Medicaid