Basic Information
| Provider Information | |||||||||
| NPI: | 1285062414 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | A LOVING CARE PCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 343 W BENSON BLVD STE 4 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995033950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072223237 | ||||||||
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| Practice Location | |||||||||
| Address1: | 343 W BENSON BLVD STE 4 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995033950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072223237 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2013 | ||||||||
| LastUpdateDate: | 10/25/2013 | ||||||||
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| AuthorizedOfficialLastName: | MAVAEGA | ||||||||
| AuthorizedOfficialFirstName: | ROSALINA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9076025811 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | A LOVING CARE PCA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
ID Information
| ID | Type | State | Issuer | Description | 1584754 | 05 | AK | MEDICAID |