Provider Demographics
NPI:1841327426
Name:LET US CARE ASSISTED LIVING HOME
Entity type:Organization
Organization Name:LET US CARE ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARION
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-5624
Mailing Address - Street 1:PO BOX 83966
Mailing Address - Street 2:3405 SANDVIK STREET
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-3966
Mailing Address - Country:US
Mailing Address - Phone:907-452-5624
Mailing Address - Fax:
Practice Address - Street 1:3405 SANDVIK ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3904
Practice Address - Country:US
Practice Address - Phone:907-452-5624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK303745310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
216787OtherGRANT PROVIDER NUMBER
FY 200612007OtherDHS & DSDS STATE OF AK
AKRL 4244Medicaid