Provider Demographics
NPI:1295040418
Name:JAHATEH, ISATOU
Entity Type:Individual
Prefix:
First Name:ISATOU
Middle Name:
Last Name:JAHATEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 W 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3183
Mailing Address - Country:US
Mailing Address - Phone:907-360-2199
Mailing Address - Fax:
Practice Address - Street 1:2211 W 47TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3183
Practice Address - Country:US
Practice Address - Phone:907-360-2199
Practice Address - Fax:907-677-6327
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK944556310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility