Provider Demographics
NPI:1780997379
Name:BALGENORTH, JOSEPHINE SELERIANA
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:SELERIANA
Last Name:BALGENORTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 ALPHA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-2253
Mailing Address - Country:US
Mailing Address - Phone:907-727-4723
Mailing Address - Fax:907-332-6260
Practice Address - Street 1:4941 ALPHA CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-2253
Practice Address - Country:US
Practice Address - Phone:907-727-4723
Practice Address - Fax:907-332-6260
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-23
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100788310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility