Provider Demographics
NPI:1295958825
Name:SENIOR CARE SPECIALISTS
Entity type:Organization
Organization Name:SENIOR CARE SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDA
Authorized Official - Middle Name:COLLEEN
Authorized Official - Last Name:FROMMER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-868-3100
Mailing Address - Street 1:1801 E DOWLING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-1918
Mailing Address - Country:US
Mailing Address - Phone:907-868-3100
Mailing Address - Fax:907-868-4658
Practice Address - Street 1:1801 E DOWLING RD STE 300
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1918
Practice Address - Country:US
Practice Address - Phone:907-868-3100
Practice Address - Fax:907-868-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK730533251B00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC3503Medicaid
AKPCG908Medicaid