Provider Demographics
NPI:1609127166
Name:KEEN EYE CARE ASSISTED LIVING INC
Entity Type:Organization
Organization Name:KEEN EYE CARE ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR /ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-394-4200
Mailing Address - Street 1:382 S KOBUK ST
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7831
Mailing Address - Country:US
Mailing Address - Phone:907-394-4200
Mailing Address - Fax:
Practice Address - Street 1:382 S KOBUK ST
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7831
Practice Address - Country:US
Practice Address - Phone:907-394-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1030303Medicaid