Provider Demographics
NPI:1194588913
Name:ASANTE COMMUNITY SERVICES, LLC
Entity type:Organization
Organization Name:ASANTE COMMUNITY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:OWINO
Authorized Official - Last Name:JUMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-822-1687
Mailing Address - Street 1:1017 27TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6900
Mailing Address - Country:US
Mailing Address - Phone:917-822-1687
Mailing Address - Fax:
Practice Address - Street 1:1017 27TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6900
Practice Address - Country:US
Practice Address - Phone:917-822-1687
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care