Provider Demographics
NPI:1588216097
Name:GRAYSTONE ASSISTED LIVING HOME LLC
Entity Type:Organization
Organization Name:GRAYSTONE ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SENNEH
Authorized Official - Middle Name:
Authorized Official - Last Name:AMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-222-0970
Mailing Address - Street 1:3401 GREENLAND DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-2062
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:922 CHERRY ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2229
Practice Address - Country:US
Practice Address - Phone:907-222-0970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health