Provider Demographics
NPI:1548795677
Name:HEA LANI ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:HEA LANI ASSISTED LIVING HOME
Other - Org Name:N/A
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:SAPLA
Authorized Official - Last Name:UMAYAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-230-1140
Mailing Address - Street 1:1756 S HEATHER MEADOWS LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3864
Mailing Address - Country:US
Mailing Address - Phone:907-230-1140
Mailing Address - Fax:907-222-1281
Practice Address - Street 1:1756 S HEATHER MEADOWS LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3864
Practice Address - Country:US
Practice Address - Phone:907-230-1140
Practice Address - Fax:907-222-1281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK121277Medicaid