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Organization
IMMACULATED CONCEPCION
Active
Organization
IMMACULATED CONCEPCION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANEPHERE LORENZANA (OWNER/ADMINISTRATOR)
(907) 903-7446
Entity
Organization
Contact information
Practice address
1836 LAURA CIR, ANCHORAGE, AK 99508-3516
(907) 332-0158
(907) 332-0158
Mailing address
1836 LAURA CIR, ANCHORAGE, AK 99508-3516
(907) 332-0158
(907) 332-0158
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7090913
DRIVERS LICENSE
AK
Enumeration date
04/13/2018
Last updated
04/13/2018
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