Provider Demographics
NPI:1073094439
Name:HRG HEALTHCARE LLC
Entity Type:Organization
Organization Name:HRG HEALTHCARE LLC
Other - Org Name:MOUNT ZION ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AIKO MARIE
Authorized Official - Middle Name:OBAH
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-582-5991
Mailing Address - Street 1:6720 E 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1822
Mailing Address - Country:US
Mailing Address - Phone:907-677-0286
Mailing Address - Fax:
Practice Address - Street 1:6720 E 11TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1822
Practice Address - Country:US
Practice Address - Phone:907-677-0286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101273310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility