Provider Demographics
NPI:1235670795
Name:ALASKA CARE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ALASKA CARE ASSISTED LIVING LLC
Other - Org Name:ALASKA CARE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-227-5306
Mailing Address - Street 1:11950 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3129
Mailing Address - Country:US
Mailing Address - Phone:907-227-5306
Mailing Address - Fax:907-929-3121
Practice Address - Street 1:3120 W 79TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4406
Practice Address - Country:US
Practice Address - Phone:907-227-5306
Practice Address - Fax:907-929-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101221310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKN/AMedicaid