Provider Demographics
NPI:1497167894
Name:BOREALIS ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:BOREALIS ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INSUK
Authorized Official - Middle Name:
Authorized Official - Last Name:FRISING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-388-1200
Mailing Address - Street 1:1521 HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4015
Mailing Address - Country:US
Mailing Address - Phone:907-456-6700
Mailing Address - Fax:907-456-6701
Practice Address - Street 1:1521 HILTON AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4015
Practice Address - Country:US
Practice Address - Phone:907-456-6700
Practice Address - Fax:907-456-6701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK994946310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility