Provider Demographics
NPI:1932482619
Name:ELAINE'S PLACE
Entity Type:Organization
Organization Name:ELAINE'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:HUTCHENS-ETHEREDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-677-6375
Mailing Address - Street 1:1025 H ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-3430
Mailing Address - Country:US
Mailing Address - Phone:907-677-6375
Mailing Address - Fax:907-677-6374
Practice Address - Street 1:1025 H ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3430
Practice Address - Country:US
Practice Address - Phone:907-677-6375
Practice Address - Fax:907-677-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100529311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1030313Medicaid