Provider Demographics
NPI:1346367265
Name:GENEVIEVE ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:GENEVIEVE ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:MINA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-230-0876
Mailing Address - Street 1:3627 RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4526
Mailing Address - Country:US
Mailing Address - Phone:907-561-7529
Mailing Address - Fax:907-222-2419
Practice Address - Street 1:1922 LOGAN ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3281
Practice Address - Country:US
Practice Address - Phone:907-222-1980
Practice Address - Fax:907-222-2419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL3276Medicaid
AKRL3627Medicaid
AKHC3627Medicaid
AKRL36271Medicaid
ALHC36271Medicaid