Provider Demographics
NPI:1801380043
Name:ANCORA HOME HEALTH & HOSPICE, LLC
Entity Type:Organization
Organization Name:ANCORA HOME HEALTH & HOSPICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:CHAD
Authorized Official - Last Name:MANGUM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:435-881-9601
Mailing Address - Street 1:2851 E PALMER WASILLA HWY STE 7
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7499
Mailing Address - Country:US
Mailing Address - Phone:907-561-9240
Mailing Address - Fax:866-934-0349
Practice Address - Street 1:3831 E BLUE LUPINE DR STE B
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8461
Practice Address - Country:US
Practice Address - Phone:907-561-9240
Practice Address - Fax:866-934-0349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA