Provider Demographics
NPI:1942413851
Name:MELISSA D HUTCHENS
Entity Type:Organization
Organization Name:MELISSA D HUTCHENS
Other - Org Name:ELAINES PLACE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER SOLE PROPRIETOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:DANNETTE
Authorized Official - Last Name:HUTCHENS
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER SOLE PROPRIETO
Authorized Official - Phone:907-250-8901
Mailing Address - Street 1:1025 H STREET
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501
Mailing Address - Country:US
Mailing Address - Phone:907-677-6375
Mailing Address - Fax:907-677-6374
Practice Address - Street 1:1025 H STREET
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501
Practice Address - Country:US
Practice Address - Phone:907-677-6375
Practice Address - Fax:907-677-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK436405310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL5983Medicaid