Provider Demographics
NPI:1740595172
Name:RABE ASSISTED LIVING HOME,LLC
Entity Type:Organization
Organization Name:RABE ASSISTED LIVING HOME,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:SELERIANA
Authorized Official - Last Name:BALGENORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-727-4723
Mailing Address - Street 1:4941 ALPHA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99516-2253
Mailing Address - Country:US
Mailing Address - Phone:907-336-6260
Mailing Address - Fax:
Practice Address - Street 1:4941 ALPHA CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99516-2253
Practice Address - Country:US
Practice Address - Phone:907-336-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100788251S00000X, 310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRLXMedicaid
AKHCXMedicaid