Provider Demographics
NPI:1124392840
Name:AOFALASKA LLC
Entity Type:Organization
Organization Name:AOFALASKA LLC
Other - Org Name:MOUNTAIN VISTA ALH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DARCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HIETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-244-9504
Mailing Address - Street 1:19412 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577
Mailing Address - Country:US
Mailing Address - Phone:907-244-9504
Mailing Address - Fax:
Practice Address - Street 1:19412 FIRST ST
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-244-9504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-27
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100803320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities