Provider Demographics
NPI:1669250577
Name:INTEL-CARE ALASKA LLC
Entity type:Organization
Organization Name:INTEL-CARE ALASKA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:TENNANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-342-9328
Mailing Address - Street 1:1011 BOSTON ST STE 103
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2031
Mailing Address - Country:US
Mailing Address - Phone:907-342-9328
Mailing Address - Fax:
Practice Address - Street 1:1011 BOSTON ST STE 103
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2031
Practice Address - Country:US
Practice Address - Phone:907-342-9328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness