Provider Demographics
NPI:1396017620
Name:GOLDEN FRIENDSHIP ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:GOLDEN FRIENDSHIP ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:CUELA
Authorized Official - Last Name:CARDANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-332-0885
Mailing Address - Street 1:3847 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-6601
Mailing Address - Country:US
Mailing Address - Phone:907-332-0885
Mailing Address - Fax:907-332-0376
Practice Address - Street 1:3847 SCENIC VIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6601
Practice Address - Country:US
Practice Address - Phone:907-332-0885
Practice Address - Fax:907-332-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100943310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility