Organization
ONE SOURCE HOME CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SABRINA SUE CARDINAL (CHIEF OPERATING OFFICER/PARTNER)
(907) 500-3146
Entity
Organization
Contact information
Practice address
9205 JAMES BLVD APT 102, JUNEAU, AK 99801-9671
(907) 500-3146
(907) 308-6707
Mailing address
PO BOX 492, CROOKSTON, MN 56716-0492
(907) 500-3146
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
UNKNOWN
—
AK
Enumeration date
02/10/2020
Last updated
09/11/2020
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