Provider Demographics
NPI:1871821082
Name:MY DAUGHTER AND ME ASSISTED LIVING HOME, LTD.
Entity Type:Organization
Organization Name:MY DAUGHTER AND ME ASSISTED LIVING HOME, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:907-830-3055
Mailing Address - Street 1:3408 N STAR ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-4539
Mailing Address - Country:US
Mailing Address - Phone:907-830-3055
Mailing Address - Fax:907-770-7903
Practice Address - Street 1:3408 N STAR ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-4539
Practice Address - Country:US
Practice Address - Phone:907-830-3055
Practice Address - Fax:907-770-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-27
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK233347C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK347C0000XMedicaid
AK385H0000XMedicaid