Provider Demographics
NPI:1508085812
Name:EVELYN S MENESES,EM CARE ALASKA
Entity Type:Organization
Organization Name:EVELYN S MENESES,EM CARE ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER- ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:SANTOS
Authorized Official - Last Name:MENESES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-351-8237
Mailing Address - Street 1:1643 BEAVER PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2518
Mailing Address - Country:US
Mailing Address - Phone:907-337-0313
Mailing Address - Fax:907-337-8080
Practice Address - Street 1:1643 BEAVER PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2518
Practice Address - Country:US
Practice Address - Phone:907-337-0313
Practice Address - Fax:907-337-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK943917253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPCG014Medicaid