Provider Demographics
NPI:1689010290
Name:ST THOMAS ASSISTED LIVING HOMES LLC
Entity Type:Organization
Organization Name:ST THOMAS ASSISTED LIVING HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FLEDZ
Authorized Official - Middle Name:LERIOS
Authorized Official - Last Name:LASTIMOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-868-3115
Mailing Address - Street 1:6885 TOWN AND COUNTRY PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-2845
Mailing Address - Country:US
Mailing Address - Phone:907-868-3115
Mailing Address - Fax:907-865-3255
Practice Address - Street 1:6885 TOWN AND COUNTRY PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2845
Practice Address - Country:US
Practice Address - Phone:907-868-3115
Practice Address - Fax:907-865-3255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100720310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL5298/RL52981Medicaid