Provider Demographics
NPI:1528548757
Name:POTALA ALH
Entity Type:Organization
Organization Name:POTALA ALH
Other - Org Name:POTALA ALH
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TSEWANG
Authorized Official - Middle Name:CHUKI
Authorized Official - Last Name:TSANGWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-522-2157
Mailing Address - Street 1:2115 MISTYBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4641
Mailing Address - Country:US
Mailing Address - Phone:907-522-2157
Mailing Address - Fax:
Practice Address - Street 1:2115 MISTYBROOK CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4641
Practice Address - Country:US
Practice Address - Phone:907-522-2157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility