Provider Demographics
NPI:1245448265
Name:CONSUMER CARE NETWORK INC
Entity type:Organization
Organization Name:CONSUMER CARE NETWORK INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OGBOUMA
Authorized Official - Middle Name:OKE
Authorized Official - Last Name:ULOFOSHIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-529-1572
Mailing Address - Street 1:PO BOX 111761
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-1761
Mailing Address - Country:US
Mailing Address - Phone:907-334-3050
Mailing Address - Fax:
Practice Address - Street 1:440 W BENSON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3860
Practice Address - Country:US
Practice Address - Phone:907-529-1572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK433132251X00000X, 385HR2065X
AK251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251X00000XAgenciesSupports Brokerage
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC03591Medicaid