Provider Demographics
NPI:1912405770
Name:IN HIS IMAGE LLC
Entity Type:Organization
Organization Name:IN HIS IMAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-230-8707
Mailing Address - Street 1:2956 SHELDON JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4470
Mailing Address - Country:US
Mailing Address - Phone:907-230-8707
Mailing Address - Fax:907-222-3832
Practice Address - Street 1:2956 SHELDON JACKSON ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4470
Practice Address - Country:US
Practice Address - Phone:907-230-8707
Practice Address - Fax:907-222-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101277311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility