Provider Demographics
NPI:1629713623
Name:DENALI CARE SERVICES, LLC.
Entity Type:Organization
Organization Name:DENALI CARE SERVICES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ENI
Authorized Official - Middle Name:IERUSALEMA
Authorized Official - Last Name:MAVAEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-297-8942
Mailing Address - Street 1:31620 23RD AVE S # 302
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5064
Mailing Address - Country:US
Mailing Address - Phone:206-592-2756
Mailing Address - Fax:206-238-9450
Practice Address - Street 1:31620 23RD AVE S # 302
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5064
Practice Address - Country:US
Practice Address - Phone:206-592-2756
Practice Address - Fax:206-238-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty