Provider Demographics
NPI:1053443572
Name:ADELA ASSISTED LIVING HOME INC.
Entity Type:Organization
Organization Name:ADELA ASSISTED LIVING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORA
Authorized Official - Middle Name:SANCHEZ
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-522-2783
Mailing Address - Street 1:8601 GEIRINHAS PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3682
Mailing Address - Country:US
Mailing Address - Phone:907-522-2783
Mailing Address - Fax:907-644-8530
Practice Address - Street 1:7940 LADASA PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3052
Practice Address - Country:US
Practice Address - Phone:907-522-2783
Practice Address - Fax:907-644-8530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK61310400000X
AKHC5286385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL5286Medicaid
AKHC5286Medicaid