Provider Demographics
NPI:1740683861
Name:COMPASSIONATE AVIANA INC
Entity type:Organization
Organization Name:COMPASSIONATE AVIANA INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BAYKHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KEODOUANGDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-317-9657
Mailing Address - Street 1:3007 ARCTIC BLVD
Mailing Address - Street 2:SPACE 2
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3478
Mailing Address - Country:US
Mailing Address - Phone:907-317-9657
Mailing Address - Fax:
Practice Address - Street 1:3007 ARCTIC BLVD
Practice Address - Street 2:SPACE 2
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3478
Practice Address - Country:US
Practice Address - Phone:907-317-9657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management