Provider Demographics
NPI:1952528531
Name:DIGNIFIED HOME LIFE CARE
Entity type:Organization
Organization Name:DIGNIFIED HOME LIFE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BELZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:907-333-2968
Mailing Address - Street 1:3330 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4027
Mailing Address - Country:US
Mailing Address - Phone:907-333-2968
Mailing Address - Fax:907-333-2968
Practice Address - Street 1:3330 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4027
Practice Address - Country:US
Practice Address - Phone:907-333-2968
Practice Address - Fax:907-333-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000113310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL7520Medicaid