Provider Demographics
NPI:1982828224
Name:HOMER SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:HOMER SENIOR CITIZENS, INC.
Other - Org Name:FRIENDSHIP TERRACE ASSISTED LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:L
Authorized Official - Last Name:LAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-235-7655
Mailing Address - Street 1:3935 SVEDLUND ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7673
Mailing Address - Country:US
Mailing Address - Phone:907-235-7655
Mailing Address - Fax:907-235-3739
Practice Address - Street 1:3935 SVEDLUND ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7673
Practice Address - Country:US
Practice Address - Phone:907-235-7655
Practice Address - Fax:907-235-3739
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
AK000053310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL7789Medicaid