Provider Demographics
NPI:1508474610
Name:DABAKH ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:DABAKH ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BABA
Authorized Official - Middle Name:
Authorized Official - Last Name:SY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-350-0061
Mailing Address - Street 1:3760 W 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-2862
Mailing Address - Country:US
Mailing Address - Phone:907-350-0061
Mailing Address - Fax:907-868-1592
Practice Address - Street 1:3760 W 74TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2862
Practice Address - Country:US
Practice Address - Phone:907-350-0061
Practice Address - Fax:907-868-1592
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DABAKH ASSISTED LIVING HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1678891Medicaid