Provider Demographics
NPI:1700191368
Name:A COZY COTTAGE ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:A COZY COTTAGE ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KANDACE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-903-0575
Mailing Address - Street 1:2812 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1701
Mailing Address - Country:US
Mailing Address - Phone:907-245-0521
Mailing Address - Fax:907-245-0621
Practice Address - Street 1:2812 W 29TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99517-1701
Practice Address - Country:US
Practice Address - Phone:907-245-0521
Practice Address - Fax:907-245-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-07
Last Update Date:2010-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100842310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility