Provider Demographics
NPI: | 1942753454 |
---|---|
Name: | SUNSHINE HAVEN ASSISTED LIVING HOME LLC |
Entity Type: | Organization |
Organization Name: | SUNSHINE HAVEN ASSISTED LIVING HOME LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | KULAEA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SIULUA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 907-887-4416 |
Mailing Address - Street 1: | 324 DEWEY CIR |
Mailing Address - Street 2: | |
Mailing Address - City: | ANCHORAGE |
Mailing Address - State: | AK |
Mailing Address - Zip Code: | 99508-2235 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 907-887-4416 |
Mailing Address - Fax: | 907-929-0342 |
Practice Address - Street 1: | 324 DEWEY CIR |
Practice Address - Street 2: | |
Practice Address - City: | ANCHORAGE |
Practice Address - State: | AK |
Practice Address - Zip Code: | 99508-2235 |
Practice Address - Country: | US |
Practice Address - Phone: | 907-887-4416 |
Practice Address - Fax: | 907-929-0342 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2016-08-01 |
Last Update Date: | 2016-08-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AK | 1028643 | 311Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility |