Provider Demographics
NPI:1174645584
Name:JAMIEZON ALH
Entity Type:Organization
Organization Name:JAMIEZON ALH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:P
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-868-5296
Mailing Address - Street 1:2280 LAKE GEORGE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3517
Mailing Address - Country:US
Mailing Address - Phone:907-868-5296
Mailing Address - Fax:907-337-5296
Practice Address - Street 1:2280 LAKE GEORGE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3517
Practice Address - Country:US
Practice Address - Phone:907-868-5296
Practice Address - Fax:907-337-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100486310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL 6544Medicaid