Provider Demographics
NPI:1801371927
Name:SKYLINE ASSISTED LIVING HOME LLC
Entity Type:Organization
Organization Name:SKYLINE ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:FRANKLYN
Authorized Official - Last Name:OTCHECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-598-1992
Mailing Address - Street 1:63540 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-9333
Mailing Address - Country:US
Mailing Address - Phone:907-266-2266
Mailing Address - Fax:907-226-2265
Practice Address - Street 1:63540 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-9333
Practice Address - Country:US
Practice Address - Phone:907-266-2266
Practice Address - Fax:907-226-2265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SKYLINE ASSISTED LIVING HOME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1055911OtherALASKA BUSINESS LICENSE
AK10620OtherASSISTED LIVING HOME LICENSE