Provider Demographics
NPI:1033702881
Name:FAMILY CARE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:FAMILY CARE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MENIME
Authorized Official - Middle Name:
Authorized Official - Last Name:SEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-306-9776
Mailing Address - Street 1:2221 W 46TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3162
Mailing Address - Country:US
Mailing Address - Phone:907-306-9776
Mailing Address - Fax:
Practice Address - Street 1:3120 W 79TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4406
Practice Address - Country:US
Practice Address - Phone:907-306-9776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty