Provider Demographics
NPI:1477671063
Name:DIVISION OF ALASKAN PIONEER HOMES
Entity Type:Organization
Organization Name:DIVISION OF ALASKAN PIONEER HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:COTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:907-465-5737
Mailing Address - Street 1:P.O. BOX 110690
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99811-0690
Mailing Address - Country:US
Mailing Address - Phone:907-465-5737
Mailing Address - Fax:907-465-4108
Practice Address - Street 1:250 EAST FIREWEED
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6699
Practice Address - Country:US
Practice Address - Phone:907-465-5737
Practice Address - Fax:907-465-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL1185Medicaid