Healthcare Provider Details

I. General information

NPI: 1831423540
Provider Name (Legal Business Name): TRUE LOVE ASSISTED LIVING HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2009
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 NORTHWOOD ST
ANCHORAGE AK
99502-4663
US

IV. Provider business mailing address

8340 NORTHWOOD ST
ANCHORAGE AK
99502-4663
US

V. Phone/Fax

Practice location:
  • Phone: 907-929-7290
  • Fax: 907-929-7240
Mailing address:
  • Phone: 907-929-7290
  • Fax: 907-929-7240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number100786
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number100786
License Number StateAK

VIII. Authorized Official

Name: MARK MILITELLO
Title or Position: OWNER
Credential:
Phone: 907-929-7290