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
StateLicense IDTaxonomies
AK1028643311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility