Provider Demographics
NPI:1750935433
Name:MIND AND SOUL ASSISTED LIVING, LLC
Entity type:Organization
Organization Name:MIND AND SOUL ASSISTED LIVING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-350-3878
Mailing Address - Street 1:6233 GERONIMO CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1659
Mailing Address - Country:US
Mailing Address - Phone:907-350-3878
Mailing Address - Fax:
Practice Address - Street 1:6124 E 12TH AVE # D2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2355
Practice Address - Country:US
Practice Address - Phone:907-350-3878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals