Healthcare Provider Details

I. General information

NPI: 1528358207
Provider Name (Legal Business Name): DIVINE MERCY II ALH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E 11TH AVE APT 5
ANCHORAGE AK
99501-4560
US

IV. Provider business mailing address

3554 NEWCOMB DRIVE
ANCHORAGE AK
99508-4852
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-9148
  • Fax: 907-770-9149
Mailing address:
  • Phone: 907-868-8608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number100892
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number100892
License Number StateAK

VIII. Authorized Official

Name: MRS. ELIEZER LIMUN PENTECOSTES
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 907-868-8608