Provider Demographics
NPI:1699952358
Name:ALASKA FAMILY WELLNESS CENTER INC
Entity type:Organization
Organization Name:ALASKA FAMILY WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:SAADY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-561-9444
Mailing Address - Street 1:4200 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5226
Mailing Address - Country:US
Mailing Address - Phone:907-561-9444
Mailing Address - Fax:907-561-9446
Practice Address - Street 1:4200 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 304
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5226
Practice Address - Country:US
Practice Address - Phone:907-561-9444
Practice Address - Fax:907-561-9446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
302F00000X
AK2741302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK27412Medicaid
AK27412Medicaid