Healthcare Provider Details

I. General information

NPI: 1235942822
Provider Name (Legal Business Name): PRECIOUS MEMORY ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2025
Last Update Date: 01/29/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12143 ROLLING MEADOW CIR
ANCHORAGE AK
99516-2066
US

IV. Provider business mailing address

12143 ROLLING MEADOW CIR
ANCHORAGE AK
99516-2066
US

V. Phone/Fax

Practice location:
  • Phone: 907-313-9624
  • Fax:
Mailing address:
  • Phone: 907-313-9624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: LEO CHEN
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 907-313-9624