Provider Demographics
NPI:1255302386
Name:WILDFLOWER COURT INC
Entity type:Organization
Organization Name:WILDFLOWER COURT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-463-8712
Mailing Address - Street 1:2000 SALMON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7801
Mailing Address - Country:US
Mailing Address - Phone:907-463-8700
Mailing Address - Fax:907-463-8743
Practice Address - Street 1:2000 SALMON CREEK LN
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7801
Practice Address - Country:US
Practice Address - Phone:907-463-8700
Practice Address - Fax:907-463-8743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK277668314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKLTO153Medicaid
AKLTO153Medicaid