Provider Demographics
NPI:1255457313
Name:KACHEMAK WAY ASSISTED LIVING, INC.
Entity type:Organization
Organization Name:KACHEMAK WAY ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-235-6327
Mailing Address - Street 1:4201 KACHEMAK WAY
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7144
Mailing Address - Country:US
Mailing Address - Phone:907-235-6327
Mailing Address - Fax:907-235-6149
Practice Address - Street 1:4201 KACHEMAK WAY
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7144
Practice Address - Country:US
Practice Address - Phone:907-235-6327
Practice Address - Fax:907-235-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK138343900000X, 385H00000X
AK00138310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL3539Medicaid