Provider Demographics
NPI:1902022262
Name:HARBOR LIGHTS HOUSE ASSISTED LIVING, INC.
Entity Type:Organization
Organization Name:HARBOR LIGHTS HOUSE ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-5355
Mailing Address - Street 1:39355 DUDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8603
Mailing Address - Country:US
Mailing Address - Phone:907-262-5355
Mailing Address - Fax:
Practice Address - Street 1:39355 DUDLEY AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8603
Practice Address - Country:US
Practice Address - Phone:907-262-5355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000249310400000X
AK249347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC6259Medicaid
AKRL6259Medicaid