Provider Demographics
NPI:1093986721
Name:LECRIS HAVEN ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:LECRIS HAVEN ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISALYN BUENARTE
Authorized Official - Middle Name:B
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-306-2054
Mailing Address - Street 1:3541 CORONA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1486
Mailing Address - Country:US
Mailing Address - Phone:907-306-2054
Mailing Address - Fax:907-677-0974
Practice Address - Street 1:2108 W 47TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3165
Practice Address - Country:US
Practice Address - Phone:907-770-5915
Practice Address - Fax:907-677-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100656251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health