Provider Demographics
NPI:1508189945
Name:PROFESSIONAL CARE SERVICE
Entity Type:Organization
Organization Name:PROFESSIONAL CARE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNED
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:URENA
Authorized Official - Suffix:I
Authorized Official - Credentials:051368
Authorized Official - Phone:907-346-4410
Mailing Address - Street 1:1743 MINERVA WAY
Mailing Address - Street 2:SAME
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1490
Mailing Address - Country:US
Mailing Address - Phone:907-346-4410
Mailing Address - Fax:907-346-4412
Practice Address - Street 1:1743 MINERVA WAY
Practice Address - Street 2:SAME
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1490
Practice Address - Country:US
Practice Address - Phone:907-346-4410
Practice Address - Fax:907-346-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK928682320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities