Provider Demographics
NPI:1699392035
Name:OPEN ARMS ASSISTED LIVING WEST LLC
Entity Type:Organization
Organization Name:OPEN ARMS ASSISTED LIVING WEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:TYRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-367-3763
Mailing Address - Street 1:3844 HELVETIA DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5016
Mailing Address - Country:US
Mailing Address - Phone:860-367-3763
Mailing Address - Fax:
Practice Address - Street 1:3660 W 78TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-4471
Practice Address - Country:US
Practice Address - Phone:860-367-3763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility