Provider Demographics
NPI:1841638707
Name:FIDELITY ASSISTED LIVING
Entity type:Organization
Organization Name:FIDELITY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AURORA
Authorized Official - Middle Name:GARCIA
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:907-229-3717
Mailing Address - Street 1:6133 E 12TH AVE
Mailing Address - Street 2:6133 E 12 AVE
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2320
Mailing Address - Country:US
Mailing Address - Phone:907-229-3717
Mailing Address - Fax:907-245-4362
Practice Address - Street 1:6133 E 12TH AVE
Practice Address - Street 2:6133 E 12 AVE
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2320
Practice Address - Country:US
Practice Address - Phone:907-229-3717
Practice Address - Fax:907-245-4362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100774310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility