Provider Demographics
NPI:1578781480
Name:BARBARA S. LARSON
Entity Type:Organization
Organization Name:BARBARA S. LARSON
Other - Org Name:BLAGODAT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VARVARA (BARBARA)
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDIAKINA-LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:BA MDIV, CHAPLAIN
Authorized Official - Phone:907-260-3975
Mailing Address - Street 1:35555 KENAI SPUR HWY PMB 406
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7625
Mailing Address - Country:US
Mailing Address - Phone:907-260-3975
Mailing Address - Fax:907-262-3883
Practice Address - Street 1:35555 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7625
Practice Address - Country:US
Practice Address - Phone:907-260-3975
Practice Address - Fax:907-262-3883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG397Medicaid