Provider Demographics
NPI:1770606543
Name:KIWI ASSISTED LIVING HOME
Entity type:Organization
Organization Name:KIWI ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:BOLLOZOS
Authorized Official - Last Name:FRANCISCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-227-5573
Mailing Address - Street 1:1800 NORTHWESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4429
Mailing Address - Country:US
Mailing Address - Phone:907-227-5573
Mailing Address - Fax:907-274-2752
Practice Address - Street 1:1800 NORTHWESTERN AVE.
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4429
Practice Address - Country:US
Practice Address - Phone:907-227-5573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK310400000X310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility