Provider Demographics
NPI:1679754303
Name:EASTER SEALS OF ALASKA
Entity type:Organization
Organization Name:EASTER SEALS OF ALASKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:V
Authorized Official - Middle Name:
Authorized Official - Last Name:GUITERREZ-OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-277-7325
Mailing Address - Street 1:670 W FIREWEED LN STE 105
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2562
Mailing Address - Country:US
Mailing Address - Phone:907-277-7325
Mailing Address - Fax:907-272-7325
Practice Address - Street 1:670 W FIREWEED LN STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2562
Practice Address - Country:US
Practice Address - Phone:907-277-7325
Practice Address - Fax:907-272-7325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-22
Last Update Date:2007-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC1831Medicaid