Provider Demographics
NPI:1295092153
Name:ALASKA PREMIUM CARE, INC
Entity type:Organization
Organization Name:ALASKA PREMIUM CARE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:DEMOSS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-223-2533
Mailing Address - Street 1:8431 CORMORANT COVE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5001
Mailing Address - Country:US
Mailing Address - Phone:907-644-1000
Mailing Address - Fax:
Practice Address - Street 1:2683 WESLEYAN DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3700
Practice Address - Country:US
Practice Address - Phone:907-227-5306
Practice Address - Fax:907-677-0433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKRLX310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1578224Medicaid
AK1609011Medicaid