| NPI | 1376638171 |
|---|---|
| Doing Business As | PROVIDENCE EXTENDED CARE CENTER |
| Entity Type | Organization |
| Authorized Contact | BRUCE LAMOUREUX CEO 907-212-5682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: AK NOT NUMBERED) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2012-01-31 |