Provider Demographics
NPI:1982827218
Name:CHRISTIAN COTTAGE 3
Entity Type:Organization
Organization Name:CHRISTIAN COTTAGE 3
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OFELIA
Authorized Official - Middle Name:ISENIA
Authorized Official - Last Name:GUIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-250-6089
Mailing Address - Street 1:6400 CHEVIGNY ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-2028
Mailing Address - Country:US
Mailing Address - Phone:907-250-6089
Mailing Address - Fax:907-338-8164
Practice Address - Street 1:6400 CHEVIGNY ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2028
Practice Address - Country:US
Practice Address - Phone:907-250-6089
Practice Address - Fax:907-338-8164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000292310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL23733Medicaid