Provider Demographics
NPI:1750504189
Name:NORTHERN LIGHTS ALH LLC
Entity Type:Organization
Organization Name:NORTHERN LIGHTS ALH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEKS
Authorized Official - Middle Name:N/A
Authorized Official - Last Name:PROST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-277-0378
Mailing Address - Street 1:1640 VASHON CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3145
Mailing Address - Country:US
Mailing Address - Phone:907-277-0378
Mailing Address - Fax:
Practice Address - Street 1:1640 VASHON CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3145
Practice Address - Country:US
Practice Address - Phone:907-277-0378
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL 4643Medicaid