Provider Demographics
NPI:1336391697
Name:ST THOMAS ALH II
Entity Type:Organization
Organization Name:ST THOMAS ALH II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FLEDZ
Authorized Official - Middle Name:LERIOS
Authorized Official - Last Name:LASTIMOSO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-644-1055
Mailing Address - Street 1:8401 BERRY PATCH DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-7265
Mailing Address - Country:US
Mailing Address - Phone:907-644-1055
Mailing Address - Fax:
Practice Address - Street 1:6885 TOWN AND COUNTRY PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-2845
Practice Address - Country:US
Practice Address - Phone:907-644-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100720310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1376722454Medicaid