Provider Demographics
NPI:1699394262
Name:4EVERHOME ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:4EVERHOME ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERISH
Authorized Official - Middle Name:AGRON
Authorized Official - Last Name:DURANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-917-9517
Mailing Address - Street 1:2565 W 69TH CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-2238
Mailing Address - Country:US
Mailing Address - Phone:907-917-9517
Mailing Address - Fax:
Practice Address - Street 1:2565 W 69TH CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2238
Practice Address - Country:US
Practice Address - Phone:907-917-9517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility