Provider Demographics
NPI:1356745863
Name:ISLAND BLESSINGS CARE
Entity type:Organization
Organization Name:ISLAND BLESSINGS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAUANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-538-9667
Mailing Address - Street 1:10322 CHAIN OF ROCK ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-8184
Mailing Address - Country:US
Mailing Address - Phone:907-538-9667
Mailing Address - Fax:907-929-9005
Practice Address - Street 1:10322 CHAIN OF ROCK ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-538-9667
Practice Address - Fax:907-538-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101073385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1659773422OtherNPI