Provider Demographics
NPI:1831809953
Name:EMMANEL ASSISTED LIVING HOME WEST, INC.
Entity type:Organization
Organization Name:EMMANEL ASSISTED LIVING HOME WEST, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIA
Authorized Official - Middle Name:CRISTINA
Authorized Official - Last Name:CASTRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-750-6785
Mailing Address - Street 1:70 STEELHEAD RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3035
Mailing Address - Country:US
Mailing Address - Phone:907-750-6785
Mailing Address - Fax:877-620-9084
Practice Address - Street 1:70 STEELHEAD RD
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3035
Practice Address - Country:US
Practice Address - Phone:907-750-6785
Practice Address - Fax:877-620-9084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No174200000XOther Service ProvidersMeals
No177F00000XOther Service ProvidersLodging
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK101292OtherDEP HOME HEALTH AND SOCIAL SERVICES AK