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Organization

HEAVENLY HOME CARE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MISS SERENA FAYE WAGGONER (OWNER ADMINISTRATOR)
(907) 245-0994
Entity
Organization

Contact information

Practice address
5420 E 99TH AVE, ANCHORAGE, AK 99507-6622
(907) 245-0994
Mailing address
5420 E 99TH AVE, ANCHORAGE, AK 99507-6622
(907) 245-0994

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
000258
AK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
RL97411
AK
Enumeration date
05/18/2007
Last updated
07/15/2008
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