Provider Demographics
NPI:1114431293
Name:AK NURTURED LIVING LLC
Entity Type:Organization
Organization Name:AK NURTURED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-903-1930
Mailing Address - Street 1:17350 E DORISMAE CIR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7665
Mailing Address - Country:US
Mailing Address - Phone:907-745-3550
Mailing Address - Fax:
Practice Address - Street 1:17350 E DORISMAE CIR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7665
Practice Address - Country:US
Practice Address - Phone:907-745-3550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101120310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility