1114220233 NPI number — YOSEF FAMILY HOME

Table of content: (NPI 1114220233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114220233 NPI number — YOSEF FAMILY HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOSEF FAMILY HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114220233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6851 TAMIR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99504-3954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-720-9319
Provider Business Mailing Address Fax Number:
907-868-8034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
922 CHERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99504-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-720-9319
Provider Business Practice Location Address Fax Number:
907-868-8034
Provider Enumeration Date:
12/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
AYELE
Authorized Official First Name:
RITA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
907-720-9319

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  100843 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: COS 84 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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