Provider Demographics
NPI:1073837969
Name:KORI'S ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:KORI'S ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEAKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-748-7638
Mailing Address - Street 1:11551 VIA APPIA
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2907
Mailing Address - Country:US
Mailing Address - Phone:907-748-7638
Mailing Address - Fax:
Practice Address - Street 1:11551 VIA APPIA
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-2907
Practice Address - Country:US
Practice Address - Phone:907-748-7638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-21
Last Update Date:2010-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK940524310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility