Healthcare Provider Details

I. General information

NPI: 1740595172
Provider Name (Legal Business Name): RABE ASSISTED LIVING HOME,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4941 ALPHA CIR
ANCHORAGE AK
99516-2253
US

IV. Provider business mailing address

4941 ALPHA CIR
ANCHORAGE AK
99516-2253
US

V. Phone/Fax

Practice location:
  • Phone: 907-336-6260
  • Fax:
Mailing address:
  • Phone: 907-336-6260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number100788
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number100788
License Number StateAK

VIII. Authorized Official

Name: MRS. JOSEPHINE SELERIANA BALGENORTH
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-727-4723