Provider Demographics
NPI:1851051601
Name:CARBON ASSISTED LIVING LLC
Entity Type:Organization
Organization Name:CARBON ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHEL
Authorized Official - Middle Name:DARINE
Authorized Official - Last Name:CARBON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-519-1738
Mailing Address - Street 1:4810 SNOW CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3783
Mailing Address - Country:US
Mailing Address - Phone:907-519-1738
Mailing Address - Fax:
Practice Address - Street 1:4810 SNOW CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3783
Practice Address - Country:US
Practice Address - Phone:907-519-1738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1719817Medicaid