Provider Demographics
NPI:1578692646
Name:LAST FRONTIER ASSISTED LVG. LLC
Entity Type:Organization
Organization Name:LAST FRONTIER ASSISTED LVG. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-243-6833
Mailing Address - Street 1:4331 EDINBURGH DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-1418
Mailing Address - Country:US
Mailing Address - Phone:907-243-6833
Mailing Address - Fax:
Practice Address - Street 1:404 E FIREWEED LN
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2801
Practice Address - Country:US
Practice Address - Phone:907-243-6833
Practice Address - Fax:866-261-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCG047251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPCG047OtherMCI