Provider Demographics
NPI:1073390043
Name:NAATH ASSISTEDNLIVING HOME
Entity Type:Organization
Organization Name:NAATH ASSISTEDNLIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:K
Authorized Official - Last Name:PUOL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-222-6775
Mailing Address - Street 1:1104 W 29TH PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3746
Mailing Address - Country:US
Mailing Address - Phone:907-222-6775
Mailing Address - Fax:
Practice Address - Street 1:1104 W 29TH PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3746
Practice Address - Country:US
Practice Address - Phone:907-222-6775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness