Provider Demographics
NPI:1619432937
Name:ALASKAN RED ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:ALASKAN RED ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MALANNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VONGXAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-891-3827
Mailing Address - Street 1:PO BOX 141782
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-1782
Mailing Address - Country:US
Mailing Address - Phone:907-891-3827
Mailing Address - Fax:
Practice Address - Street 1:6291 GROSS DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2059
Practice Address - Country:US
Practice Address - Phone:907-891-3827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities