Provider Demographics
NPI:1740690486
Name:CAREL II ASSISTED LIVING HOME, LLC
Entity type:Organization
Organization Name:CAREL II ASSISTED LIVING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAVANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-952-0830
Mailing Address - Street 1:5420 AVILA CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4963
Mailing Address - Country:US
Mailing Address - Phone:907-770-1360
Mailing Address - Fax:
Practice Address - Street 1:5420 AVILA CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4963
Practice Address - Country:US
Practice Address - Phone:907-770-1360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-03
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK993851310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility