| Alaskan Amazing Grace Alh Llc | |
|
4939 Folker St Unit A Anchorage AK 99507-1456 | |
| (907) 440-3000 | |
| Not Available |
| Full Name | Alaskan Amazing Grace Alh Llc |
|---|---|
| Speciality | Counselor - Mental Health |
| Location | 4939 Folker St Unit A, Anchorage, Alaska |
| Authorized Official Name and Position | Jerry Fonseca (OWNER/ADMINISTRATOR) |
| Authorized Official Contact | 9074403000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Alaskan Amazing Grace Alh Llc 4939 Folker St Unit A Anchorage AK 99507-1456 Ph: (907) 440-3000 | Alaskan Amazing Grace Alh Llc 4939 Folker St Unit A Anchorage AK 99507-1456 Ph: (907) 440-3000 |
| NPI Number | 1508616236 |
|---|---|
| Provider Enumeration Date | 03/25/2024 |
| Last Update Date | 03/25/2024 |
| Certification Date | 03/25/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508616236 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
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