Provider Demographics
NPI:1679067888
Name:ARCTIC WOLFE ASSISTED LIVING
Entity Type:Organization
Organization Name:ARCTIC WOLFE ASSISTED LIVING
Other - Org Name:ARCTIC WOLFE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLAIDE
Authorized Official - Middle Name:TEMITOPE
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:907-317-1220
Mailing Address - Street 1:PO BOX 221876
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-1876
Mailing Address - Country:US
Mailing Address - Phone:907-317-1220
Mailing Address - Fax:907-929-5858
Practice Address - Street 1:1301 CROSS RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3904
Practice Address - Country:US
Practice Address - Phone:907-929-2828
Practice Address - Fax:907-929-5858
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSISTEDCARE SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101276310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101276OtherALASKA RESIDENTIAL LICENSE NUMBER