Provider Demographics
NPI:1265616783
Name:KAREN PUDGE DBA FORGET-ME-NOT CARE COORDINATION
Entity type:Organization
Organization Name:KAREN PUDGE DBA FORGET-ME-NOT CARE COORDINATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE EMPLOYEE PROPRIETOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:PUDGE
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:907-646-9877
Mailing Address - Street 1:PO BOX 110297
Mailing Address - Street 2:FOREGET-ME-NOT CARE COORDINATION
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-0297
Mailing Address - Country:US
Mailing Address - Phone:907-646-9877
Mailing Address - Fax:907-646-1991
Practice Address - Street 1:4350 E 145TH AVENUE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516
Practice Address - Country:US
Practice Address - Phone:907-646-9877
Practice Address - Fax:907-646-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK746363171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM861611588848097Medicaid
AKCMG8611265616783Medicaid