Provider Demographics
NPI:1558962290
Name:SUSITNA GARDENS ALH LLC
Entity type:Organization
Organization Name:SUSITNA GARDENS ALH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-743-2986
Mailing Address - Street 1:7451 TYONE CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3531
Mailing Address - Country:US
Mailing Address - Phone:907-743-2986
Mailing Address - Fax:907-743-2986
Practice Address - Street 1:7451 TYONE CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3531
Practice Address - Country:US
Practice Address - Phone:907-743-2986
Practice Address - Fax:907-743-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility