Provider Demographics
NPI:1003033069
Name:HOLY FAMILY ASSISTED LIVING HOME I
Entity Type:Organization
Organization Name:HOLY FAMILY ASSISTED LIVING HOME I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:TORRES
Authorized Official - Last Name:VALDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:907-338-7570
Mailing Address - Street 1:8600 WITHERSPOON CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4227
Mailing Address - Country:US
Mailing Address - Phone:907-338-7570
Mailing Address - Fax:907-222-6590
Practice Address - Street 1:8600 WITHERSPOON CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4227
Practice Address - Country:US
Practice Address - Phone:907-338-7570
Practice Address - Fax:907-222-6590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000081310400000X
AK6386241347C00000X
AKHC6884385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered347C00000XTransportation ServicesPrivate Vehicle
Not Answered385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL6884Medicaid
AKHC6884Medicaid