Provider Demographics
NPI:1982017711
Name:JC FAITH OPEN ARMS
Entity type:Organization
Organization Name:JC FAITH OPEN ARMS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEWBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-602-0818
Mailing Address - Street 1:PO BOX 143043
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-3043
Mailing Address - Country:US
Mailing Address - Phone:907-602-0818
Mailing Address - Fax:907-332-2732
Practice Address - Street 1:2517 W 67TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2216
Practice Address - Country:US
Practice Address - Phone:907-602-0818
Practice Address - Fax:907-332-2732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3104A0625X3104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness