Provider Demographics
NPI:1497390439
Name:BIG HEARTS ALASKA ALH, LLC
Entity Type:Organization
Organization Name:BIG HEARTS ALASKA ALH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FANGONILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-942-5366
Mailing Address - Street 1:2100 MINERVA WAY UNIT 1A
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1474
Mailing Address - Country:US
Mailing Address - Phone:907-942-5366
Mailing Address - Fax:
Practice Address - Street 1:9180 APHRODITE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1499
Practice Address - Country:US
Practice Address - Phone:907-942-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities