Provider Demographics
NPI:1326586595
Name:ALTHEA ASSISTED LIVING HOME, LLC
Entity Type:Organization
Organization Name:ALTHEA ASSISTED LIVING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAINE ADA
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-808-8224
Mailing Address - Street 1:2634B 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:907-332-3032
Mailing Address - Fax:907-332-3031
Practice Address - Street 1:2634B 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:907-332-3032
Practice Address - Fax:907-332-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101172310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility