Provider Demographics
NPI:1407476161
Name:ALASKA OLIVE CARE II, LLC
Entity Type:Organization
Organization Name:ALASKA OLIVE CARE II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-433-9189
Mailing Address - Street 1:P O BOX 1111587
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511-1157
Mailing Address - Country:US
Mailing Address - Phone:907-433-9189
Mailing Address - Fax:
Practice Address - Street 1:708 N BUNN ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1695
Practice Address - Country:US
Practice Address - Phone:907-433-9189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALASKA OLIVE CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-04-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home