Provider Demographics
NPI:1275850695
Name:LAIMA ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:LAIMA ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:BARNACHEA
Authorized Official - Last Name:PENTECOSTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-868-1106
Mailing Address - Street 1:9110 JUPITER DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3703
Mailing Address - Country:US
Mailing Address - Phone:907-868-1106
Mailing Address - Fax:907-868-7663
Practice Address - Street 1:9110 JUPITER DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3703
Practice Address - Country:US
Practice Address - Phone:907-868-1106
Practice Address - Fax:907-868-7663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-25
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100827310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility