Provider Demographics
NPI:1619590833
Name:ABBA ASSISTED LIVING HOME, LLC.
Entity Type:Organization
Organization Name:ABBA ASSISTED LIVING HOME, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DESIGNEE
Authorized Official - Prefix:
Authorized Official - First Name:BERNADITH
Authorized Official - Middle Name:METUCUA
Authorized Official - Last Name:LLOREN-PARIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-519-5067
Mailing Address - Street 1:1616 PARKWAY DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2834
Mailing Address - Country:US
Mailing Address - Phone:907-519-5067
Mailing Address - Fax:
Practice Address - Street 1:1616 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2834
Practice Address - Country:US
Practice Address - Phone:907-519-5067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities