Provider Demographics
NPI:1497425318
Name:NEW FAMILY ASSISTED LIVING
Entity Type:Organization
Organization Name:NEW FAMILY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELANA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-602-0371
Mailing Address - Street 1:PO BOX 879040
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-8900
Mailing Address - Country:US
Mailing Address - Phone:907-602-0371
Mailing Address - Fax:
Practice Address - Street 1:4151 S MEADOW DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-0465
Practice Address - Country:US
Practice Address - Phone:907-602-0371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness