Provider Demographics
NPI:1134870330
Name:DIVINE GRACE ALH
Entity type:Organization
Organization Name:DIVINE GRACE ALH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-727-5986
Mailing Address - Street 1:7940 LADASA PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-3052
Mailing Address - Country:US
Mailing Address - Phone:907-727-5986
Mailing Address - Fax:907-743-3061
Practice Address - Street 1:7940 LADASA PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-3052
Practice Address - Country:US
Practice Address - Phone:907-727-5986
Practice Address - Fax:907-743-3061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIVINE GRACE ALH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness