Provider Demographics
NPI:1265619837
Name:ST LAWRENCE ASSISTED LIVING INC
Entity type:Organization
Organization Name:ST LAWRENCE ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:SERGIO
Authorized Official - Last Name:CORRAL
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:907-336-4635
Mailing Address - Street 1:10642 BRIGANTINE CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2434
Mailing Address - Country:US
Mailing Address - Phone:907-336-4635
Mailing Address - Fax:907-245-2782
Practice Address - Street 1:9221 APHRODITE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1498
Practice Address - Country:US
Practice Address - Phone:907-336-4635
Practice Address - Fax:907-245-2782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-26
Last Update Date:2008-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK167261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service