Provider Demographics
NPI:1851580443
Name:ACACIA PERSONAL CARE SERVICES
Entity Type:Organization
Organization Name:ACACIA PERSONAL CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-338-2727
Mailing Address - Street 1:PO BOX 110042
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0042
Mailing Address - Country:US
Mailing Address - Phone:907-338-2727
Mailing Address - Fax:907-338-2704
Practice Address - Street 1:7731 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:STE 210
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3572
Practice Address - Country:US
Practice Address - Phone:907-338-2727
Practice Address - Fax:907-338-2704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251B00000X
251X00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
No251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPCG263Medicaid
AKPCG264Medicaid
AKCMG009Medicaid
AKHC26821Medicaid
AKHC2682Medicaid