Provider Demographics
NPI:1639857782
Name:COMFORT ROSE ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:COMFORT ROSE ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-529-0593
Mailing Address - Street 1:1450 N GRUBSTAKE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-5512
Mailing Address - Country:US
Mailing Address - Phone:907-315-2291
Mailing Address - Fax:
Practice Address - Street 1:1450 N GRUBSTAKE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-5512
Practice Address - Country:US
Practice Address - Phone:907-315-2291
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251J00000XAgenciesNursing Care