Provider Demographics
NPI:1730132911
Name:MAT-SU VALLEY MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:MAT-SU VALLEY MEDICAL CENTER LLC
Other - Org Name:MAT-SU REGIONAL HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR BUSINESS OFFICE SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7488
Mailing Address - Street 1:PO BOX 60000
Mailing Address - Street 2:LOCKBOX 74470
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94160
Mailing Address - Country:US
Mailing Address - Phone:907-861-6000
Mailing Address - Fax:907-861-6559
Practice Address - Street 1:3051 PALMER WASILLA HWY
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7234
Practice Address - Country:US
Practice Address - Phone:907-861-6000
Practice Address - Fax:907-861-6559
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAT-SU VALLEY MEDICAL CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-18
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK297764251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
027008Medicare Oscar/Certification