Provider Demographics
NPI:1902370042
Name:ALPENGLOW CARE COORDINATION LLC
Entity Type:Organization
Organization Name:ALPENGLOW CARE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-351-9025
Mailing Address - Street 1:200 W 34TH AVE PMB 757
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3969
Mailing Address - Country:US
Mailing Address - Phone:907-351-9025
Mailing Address - Fax:
Practice Address - Street 1:3310 LOIS DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-2036
Practice Address - Country:US
Practice Address - Phone:907-351-9025
Practice Address - Fax:855-543-4935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK11000451OtherBUSINESS LICENSE