Provider Demographics
NPI:1013748193
Name:GLYSDICARE LLC
Entity type:Organization
Organization Name:GLYSDICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-529-2248
Mailing Address - Street 1:7750 W GOLDEN DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-9235
Mailing Address - Country:US
Mailing Address - Phone:907-373-7740
Mailing Address - Fax:
Practice Address - Street 1:7750 W GOLDEN DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-9235
Practice Address - Country:US
Practice Address - Phone:907-373-7740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility