Provider Demographics
NPI:1295026730
Name:ARIANA ALH, LLC
Entity Type:Organization
Organization Name:ARIANA ALH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FIDEL
Authorized Official - Last Name:PENTECOSTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-339-0423
Mailing Address - Street 1:2634 CARROLL PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3821
Mailing Address - Country:US
Mailing Address - Phone:907-339-0423
Mailing Address - Fax:907-929-3494
Practice Address - Street 1:2634 CARROLL PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3821
Practice Address - Country:US
Practice Address - Phone:907-339-0423
Practice Address - Fax:907-929-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK952681310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRLXMedicaid