MEDICARE: CARITAS ASSISTED LIVING HOME INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	RL7356	AK

General Provider Information

NPI Number	:	1558687087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARITAS ASSISTED LIVING HOME INC.

Provider Business Mailing Address
First Line	:	1720 ADONIS DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515
Country	:	US
Telephone Number	:	907-929-4819
Fax Number	:	907-929-3819

Provider Business Practice Location Address
First Line	:	1720 ADONIS DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-1486
Country	:	US
Telephone Number	:	907-929-4819
Fax Number	:	907-929-3819

Authorized Official
Title or Position	:	VICE PRES/ADMINISTRATOR
Name	:	MRS. JOSEPHINE LADORES LUBATON
Credential	:	RN
Telephone Number	:	907-929-4819

Provider Enumeration Date	:	04/08/2010
Last Update Date	:	04/08/2010

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