Provider Demographics
NPI:1689899494
Name:COMPASSIONATE CARE ASSISTED LIVING
Entity Type:Organization
Organization Name:COMPASSIONATE CARE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:907-339-9929
Mailing Address - Street 1:235 ALASKA PL
Mailing Address - Street 2:UNIT B
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1317
Mailing Address - Country:US
Mailing Address - Phone:907-339-9929
Mailing Address - Fax:907-339-9609
Practice Address - Street 1:235 ALASKA PL
Practice Address - Street 2:UNIT B
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1317
Practice Address - Country:US
Practice Address - Phone:907-339-9929
Practice Address - Fax:907-339-9609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100442310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC2255Medicaid
AKRL2255Medicaid