Provider Demographics
NPI:1467794115
Name:ARK OF CARING LIVING ASSISTED HOME
Entity Type:Organization
Organization Name:ARK OF CARING LIVING ASSISTED HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-250-0708
Mailing Address - Street 1:2301 CANARY CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1402
Mailing Address - Country:US
Mailing Address - Phone:907-250-0708
Mailing Address - Fax:907-771-0585
Practice Address - Street 1:2301 CANARY CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1402
Practice Address - Country:US
Practice Address - Phone:907-250-0708
Practice Address - Fax:907-771-0585
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100994305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service