Provider Demographics
NPI:1760695019
Name:DEBORAH MCCARTHY
Entity Type:Organization
Organization Name:DEBORAH MCCARTHY
Other - Org Name:MOXIE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MCCARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-260-7442
Mailing Address - Street 1:44905 CARVER DR
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-6742
Mailing Address - Country:US
Mailing Address - Phone:907-260-7442
Mailing Address - Fax:
Practice Address - Street 1:44905 CARVER DR
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-6742
Practice Address - Country:US
Practice Address - Phone:907-260-7442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10770251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG624Medicaid