Basic Information
| Provider Information | |||||||||
| NPI: | 1205965142 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSISTEDCARE SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 221876 | ||||||||
| Address2: | |||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995221876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079292828 | ||||||||
| FaxNumber: | 9079295858 | ||||||||
| Practice Location | |||||||||
| Address1: | 405 E FIREWEED LN | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995032111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9079292828 | ||||||||
| FaxNumber: | 9079295858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WOLFE | ||||||||
| AuthorizedOfficialFirstName: | OLAIDE | ||||||||
| AuthorizedOfficialMiddleName: | TEMITOPE | ||||||||
| AuthorizedOfficialTitleorPosition: | PROGRAM ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9079292828 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | BSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Technician | Personal Care Attendant |
ID Information
| ID | Type | State | Issuer | Description | PCG679 | 05 | AK | MEDICAID |