Provider Demographics
NPI:1619156254
Name:ELDER OPTIONS OF ALASKA
Entity Type:Organization
Organization Name:ELDER OPTIONS OF ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HORAZDOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:BSW, MAG
Authorized Official - Phone:907-299-0352
Mailing Address - Street 1:60788 BEAR CREEK DR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-9461
Mailing Address - Country:US
Mailing Address - Phone:907-299-0352
Mailing Address - Fax:907-235-4093
Practice Address - Street 1:60788 BEAR CREEK DR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-9461
Practice Address - Country:US
Practice Address - Phone:907-299-0352
Practice Address - Fax:907-235-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
AKHC1641347C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG641Medicaid
AKHC1641Medicaid
AKCM79951Medicaid