Healthcare Provider Details

I. General information

NPI: 1013445972
Provider Name (Legal Business Name): ALASKA PREMIER ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 E 4TH AVE
ANCHORAGE AK
99508-2218
US

IV. Provider business mailing address

4635 E 4TH AVE
ANCHORAGE AK
99508-2218
US

V. Phone/Fax

Practice location:
  • Phone: 907-382-0991
  • Fax:
Mailing address:
  • Phone: 907-382-0991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ARIANA JACKSON
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 907-382-0991