Provider Demographics
NPI:1013415660
Name:PADRE PIO ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:PADRE PIO ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:BUO
Authorized Official - Last Name:BOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-350-2375
Mailing Address - Street 1:8423 DUNLAP CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1475
Mailing Address - Country:US
Mailing Address - Phone:907-350-2375
Mailing Address - Fax:907-222-4886
Practice Address - Street 1:8423 DUNLAP CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1475
Practice Address - Country:US
Practice Address - Phone:907-350-2375
Practice Address - Fax:907-222-4886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-30
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101197310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility