Provider Demographics
NPI:1780715094
Name:LAST FRONTIER ASSISTED LIVING LLC
Entity type:Organization
Organization Name:LAST FRONTIER ASSISTED LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VIOLETA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-250-8131
Mailing Address - Street 1:PO BOX 242544
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-2544
Mailing Address - Country:US
Mailing Address - Phone:907-243-6833
Mailing Address - Fax:866-261-4818
Practice Address - Street 1:404 EAST FIREWEED LANE
Practice Address - Street 2:#101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503
Practice Address - Country:US
Practice Address - Phone:907-243-6833
Practice Address - Fax:866-261-4818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385H00000XRespite Care FacilityRespite Care
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC0580Medicaid