1225151533 NPI number — SUNSET HAVEN ALH

Table of content: (NPI 1225151533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225151533 NPI number — SUNSET HAVEN ALH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUNSET HAVEN ALH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225151533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5950 KODY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANCHORAGE
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99504-5307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-337-1190
Provider Business Mailing Address Fax Number:
907-337-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4210 GALACTICA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANCHORAGE
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99517-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-243-1169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OCAMPO
Authorized Official First Name:
ANGELO
Authorized Official Middle Name:
MEDINA
Authorized Official Title or Position:
DESIGNEE ADMINISTRATOR
Authorized Official Telephone Number:
907-243-1169

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  434082 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RL 6741 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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