Provider Demographics
NPI:1851575666
Name:CRUSE, ROSALINDA A (ADMINISTRATOR)
Entity Type:Individual
Prefix:
First Name:ROSALINDA
Middle Name:A
Last Name:CRUSE
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18140 MISTY FALLS CIR
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8528
Mailing Address - Country:US
Mailing Address - Phone:907-622-4127
Mailing Address - Fax:
Practice Address - Street 1:18140 MISTY FALLS CIR
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-8528
Practice Address - Country:US
Practice Address - Phone:907-622-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-28
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100438385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK25722OtherMEDICAID TRACKING NUMBER