Provider Demographics
NPI:1265717540
Name:AURORA BOREALIS ASSISTED LIVING HOME LLC
Entity type:Organization
Organization Name:AURORA BOREALIS ASSISTED LIVING HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:POMPOSA
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:PORTERFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:907-688-2283
Mailing Address - Street 1:PO BOX 670030
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-0030
Mailing Address - Country:US
Mailing Address - Phone:907-688-2283
Mailing Address - Fax:
Practice Address - Street 1:22179 NORTH BIRCHWOOD LOOP
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567
Practice Address - Country:US
Practice Address - Phone:907-688-2283
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK939279310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility