Provider Demographics
NPI:1134441710
Name:HAINES ASSISTED LIVING, INC.
Entity type:Organization
Organization Name:HAINES ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:907-766-3616
Mailing Address - Street 1:PO BOX 916
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:AK
Mailing Address - Zip Code:99827-0916
Mailing Address - Country:US
Mailing Address - Phone:907-766-3616
Mailing Address - Fax:907-766-3617
Practice Address - Street 1:219 UNION ST.
Practice Address - Street 2:
Practice Address - City:HAINES
Practice Address - State:AK
Practice Address - Zip Code:99827-0916
Practice Address - Country:US
Practice Address - Phone:907-766-3616
Practice Address - Fax:907-766-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100793310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility