Provider Demographics
NPI:1821102757
Name:CITY OF SEWARD
Entity Type:Organization
Organization Name:CITY OF SEWARD
Other - Org Name:PROVIDENCE SEWARD MOUNTAIN HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR REIMB ADMIN & ASST SEC ENROLLMT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-525-5392
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:AK
Mailing Address - Zip Code:99664-0430
Mailing Address - Country:US
Mailing Address - Phone:907-224-5241
Mailing Address - Fax:907-224-5250
Practice Address - Street 1:2203 OAK STREET
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:AK
Practice Address - Zip Code:99664
Practice Address - Country:US
Practice Address - Phone:907-224-5241
Practice Address - Fax:907-224-5250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKNOT NUMBERED314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKLT2487Medicaid
AK025024Medicare Oscar/Certification