Provider Demographics
NPI:1477976561
Name:HORIZON ASSISTED LIVING OF FAIRBANKS LLC.
Entity Type:Organization
Organization Name:HORIZON ASSISTED LIVING OF FAIRBANKS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KILPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-978-2316
Mailing Address - Street 1:821 17TH AVE
Mailing Address - Street 2:APT 122
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6150
Mailing Address - Country:US
Mailing Address - Phone:907-978-2316
Mailing Address - Fax:
Practice Address - Street 1:821 17TH AVE
Practice Address - Street 2:APT 122
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6150
Practice Address - Country:US
Practice Address - Phone:907-978-2316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101028320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities