Provider Demographics
NPI:1700108842
Name:168, LLC
Entity Type:Organization
Organization Name:168, LLC
Other - Org Name:168 SENIOR ASSISTANCE AND ASSISTED LIVING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISITRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RODALYN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATRIMONIO-RAVAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-980-8168
Mailing Address - Street 1:2965 WENDYS WAY
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99517-1400
Mailing Address - Country:US
Mailing Address - Phone:907-980-8168
Mailing Address - Fax:907-338-8168
Practice Address - Street 1:1736 W 11TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-4206
Practice Address - Country:US
Practice Address - Phone:907-980-8168
Practice Address - Fax:907-338-8168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100806310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility