1982976437 NPI number — APHRODITE ASSISTED LIVING HOME INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982976437 NPI number — APHRODITE ASSISTED LIVING HOME INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
APHRODITE ASSISTED LIVING HOME INC.
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:
1982976437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 92393
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:
99509-2393
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-344-9442
Provider Business Mailing Address Fax Number:
907-868-1599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4009 SCENIC VIEW 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:
99504-6603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-770-5777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ROBINSON
Authorized Official First Name:
ROSIE
Authorized Official Middle Name:
JOB
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
907-230-8486

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  100548 , 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: RL16452 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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