Provider Demographics
NPI:1750604237
Name:SOUTHERN LIVING ASSISTED LIVING HOME LTD
Entity type:Organization
Organization Name:SOUTHERN LIVING ASSISTED LIVING HOME LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:TROUP
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT
Authorized Official - Phone:907-345-3416
Mailing Address - Street 1:9639 MUSKETBALL CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5389
Mailing Address - Country:US
Mailing Address - Phone:907-345-3416
Mailing Address - Fax:
Practice Address - Street 1:9639 MUSKET BALL CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5389
Practice Address - Country:US
Practice Address - Phone:907-345-3416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility