Provider Demographics
NPI:1770839110
Name:UR PRECIOUS ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:UR PRECIOUS ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:PARILLA
Authorized Official - Last Name:JUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-770-6268
Mailing Address - Street 1:1925 COLONY PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5395
Mailing Address - Country:US
Mailing Address - Phone:907-770-6268
Mailing Address - Fax:907-770-1722
Practice Address - Street 1:1925 COLONY PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5395
Practice Address - Country:US
Practice Address - Phone:907-770-6268
Practice Address - Fax:907-770-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100938320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNAMedicaid