Provider Demographics
NPI: | 1952587552 |
---|---|
Name: | LIVING STONE HOME CARE, LLC |
Entity Type: | Organization |
Organization Name: | LIVING STONE HOME CARE, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | ADMINISTTRATOR |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MAVIS |
Authorized Official - Middle Name: | AGHAYEMA |
Authorized Official - Last Name: | SLONE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 907-230-2402 |
Mailing Address - Street 1: | 5500 ALORA LOOP |
Mailing Address - Street 2: | |
Mailing Address - City: | ANCHORAGE |
Mailing Address - State: | AK |
Mailing Address - Zip Code: | 99504-1047 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 907-230-2402 |
Mailing Address - Fax: | 907-334-6405 |
Practice Address - Street 1: | 3500/3502 SKIPPER ST |
Practice Address - Street 2: | |
Practice Address - City: | ANCHORAGE |
Practice Address - State: | AK |
Practice Address - Zip Code: | 99504 |
Practice Address - Country: | US |
Practice Address - Phone: | 907-334-9213 |
Practice Address - Fax: | 907-334-6405 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2008-01-14 |
Last Update Date: | 2008-01-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AK | 100516 | 310400000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |