Provider Demographics
NPI:1982254009
Name:ARCTIC ROSE ASSISTED LIVING FACILITY LLC
Entity Type:Organization
Organization Name:ARCTIC ROSE ASSISTED LIVING FACILITY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:V
Authorized Official - Last Name:WINCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:907-917-4168
Mailing Address - Street 1:5291 N HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-1400
Mailing Address - Country:US
Mailing Address - Phone:907-917-4168
Mailing Address - Fax:855-487-3308
Practice Address - Street 1:5291 N HONEYSUCKLE LN
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-1400
Practice Address - Country:US
Practice Address - Phone:907-917-4168
Practice Address - Fax:855-487-3308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances