Provider Demographics
NPI:1013035385
Name:NORTHERN LIGHTHOUSE ASSISTED LIVING
Entity Type:Organization
Organization Name:NORTHERN LIGHTHOUSE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:S. M.
Authorized Official - Middle Name:
Authorized Official - Last Name:METTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-242-5282
Mailing Address - Street 1:PO BOX 241428
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1428
Mailing Address - Country:US
Mailing Address - Phone:907-242-5282
Mailing Address - Fax:907-276-0104
Practice Address - Street 1:307 E 24TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2105
Practice Address - Country:US
Practice Address - Phone:907-242-5282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000250310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL2466OtherRESIDENTIAL LIVING