Provider Demographics
NPI:1992242721
Name:BOUTSOMSI CARE
Entity type:Organization
Organization Name:BOUTSOMSI CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SIENH
Authorized Official - Middle Name:CINDY
Authorized Official - Last Name:BOUTSOMSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-222-5342
Mailing Address - Street 1:1641 CARA LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3851
Mailing Address - Country:US
Mailing Address - Phone:907-222-5342
Mailing Address - Fax:866-494-0141
Practice Address - Street 1:1641 CARA LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3851
Practice Address - Country:US
Practice Address - Phone:907-222-5342
Practice Address - Fax:866-494-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101219310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility