MEDICARE: SPRUCE HARBOR ASSISTED LIVING

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

General Provider Information

NPI Number	:	1982561189
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRUCE HARBOR ASSISTED LIVING

Provider Business Mailing Address
First Line	:	1120 HUFFMAN RD STE 24-346
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3516
Country	:	US
Telephone Number	:	907-350-9995
Fax Number	:

Provider Business Practice Location Address
First Line	:	4701 E 135TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-3606
Country	:	US
Telephone Number	:	907-350-9995
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MR. KELLY SNODGRASS
Credential	:
Telephone Number	:	907-242-5061

Provider Enumeration Date	:	01/08/2026
Last Update Date	:	01/08/2026

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