Provider Demographics
NPI:1225151533
Name:SUNSET HAVEN ALH
Entity Type:Organization
Organization Name:SUNSET HAVEN ALH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNEE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:MEDINA
Authorized Official - Last Name:OCAMPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-243-1169
Mailing Address - Street 1:5950 KODY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-5307
Mailing Address - Country:US
Mailing Address - Phone:907-337-1190
Mailing Address - Fax:907-337-1190
Practice Address - Street 1:4210 GALACTICA DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-1444
Practice Address - Country:US
Practice Address - Phone:907-243-1169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK434082310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL 6741Medicaid