Provider Demographics
NPI:1649471483
Name:DIGNIFIED HOME LIFE CARE INC
Entity type:Organization
Organization Name:DIGNIFIED HOME LIFE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BELZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:907-830-5316
Mailing Address - Street 1:3330 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4027
Mailing Address - Country:US
Mailing Address - Phone:907-333-2968
Mailing Address - Fax:907-333-2968
Practice Address - Street 1:3330 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4027
Practice Address - Country:US
Practice Address - Phone:907-333-2968
Practice Address - Fax:907-333-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000113385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC7520Medicaid