Provider Demographics
NPI:1639570203
Name:J&J INDEPENDENT LIVING, LLC
Entity Type:Organization
Organization Name:J&J INDEPENDENT LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-715-6507
Mailing Address - Street 1:165 E PARKS HWY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7059
Mailing Address - Country:US
Mailing Address - Phone:907-373-3953
Mailing Address - Fax:907-373-3983
Practice Address - Street 1:165 E. PARKS HWY
Practice Address - Street 2:SUITE 106
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-3909
Practice Address - Country:US
Practice Address - Phone:907-373-3953
Practice Address - Fax:907-373-3983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-14
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1002558251B00000X, 251C00000X
AK1624210251C00000X, 385H00000X
253J00000X, 320900000X
AK310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253J00000XAgenciesFoster Care Agency
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1624210Medicaid
AK1624208Medicaid