Provider Demographics
NPI:1497342620
Name:RESIDENTIAL ADULTS WITH DISABILITIES, LLC
Entity Type:Organization
Organization Name:RESIDENTIAL ADULTS WITH DISABILITIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAKNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-306-6036
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-0177
Mailing Address - Country:US
Mailing Address - Phone:907-745-1170
Mailing Address - Fax:
Practice Address - Street 1:5400 N. BONNIE DR.
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645
Practice Address - Country:US
Practice Address - Phone:907-745-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility