Provider Demographics
NPI:1023789922
Name:BETHSAIDA ASSISTED LIVING LLC
Entity type:Organization
Organization Name:BETHSAIDA ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOUSE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FESTUS
Authorized Official - Middle Name:KAYODE
Authorized Official - Last Name:JIBADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-644-3979
Mailing Address - Street 1:7080 CHAD ST
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2055
Mailing Address - Country:US
Mailing Address - Phone:907-644-3979
Mailing Address - Fax:907-677-4331
Practice Address - Street 1:7080 CHAD ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2055
Practice Address - Country:US
Practice Address - Phone:907-644-3979
Practice Address - Fax:907-677-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances