Provider Demographics
NPI:1790021251
Name:ABRA ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:ABRA ASSISTED LIVING HOME
Other - Org Name:ASSISTED LIVING HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:CAREGIVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AGAPITA
Authorized Official - Middle Name:CADIZAL
Authorized Official - Last Name:LLANEZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-522-0564
Mailing Address - Street 1:1609 BETULA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4126
Mailing Address - Country:US
Mailing Address - Phone:907-522-0564
Mailing Address - Fax:
Practice Address - Street 1:1609 BETULA CIRCLE AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4126
Practice Address - Country:US
Practice Address - Phone:907-522-0564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities