Provider Demographics
NPI:1467696641
Name:PRIMROSE SENIOR HOLDINGS, LLC
Entity Type:Organization
Organization Name:PRIMROSE SENIOR HOLDINGS, LLC
Other - Org Name:PRIMROSE RETIREMENT COMMUNITY OF WASILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTENHOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-725-3859
Mailing Address - Street 1:889 N. ELKHORN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-373-5500
Mailing Address - Fax:605-725-8754
Practice Address - Street 1:889 N. ELKHORN DRIVE
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-373-5500
Practice Address - Fax:605-725-8754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
AK100747385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL0010Medicaid