Provider Demographics
NPI:1013651223
Name:DIVINE LOVE ASSISTED LIVING HOME LLC
Entity Type:Organization
Organization Name:DIVINE LOVE ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAGSINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-947-5277
Mailing Address - Street 1:8630 KUSHTAKA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4208
Mailing Address - Country:US
Mailing Address - Phone:907-947-5277
Mailing Address - Fax:
Practice Address - Street 1:8630 KUSHTAKA CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4208
Practice Address - Country:US
Practice Address - Phone:907-947-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-24
Last Update Date:2022-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility