Provider Demographics
NPI:1518294875
Name:VALLEYWOOD ASSISTED LIVING HOME, LLC
Entity Type:Organization
Organization Name:VALLEYWOOD ASSISTED LIVING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANALYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-743-9045
Mailing Address - Street 1:2203 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-3041
Mailing Address - Country:US
Mailing Address - Phone:907-743-9094
Mailing Address - Fax:
Practice Address - Street 1:2203 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-3041
Practice Address - Country:US
Practice Address - Phone:907-743-9094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-06
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100332310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK3104Medicaid