Healthcare Provider Details

I. General information

NPI: 1851514624
Provider Name (Legal Business Name): TLC ASSISTED LIVING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 OAK DR
ANCHORAGE AK
99508-3267
US

IV. Provider business mailing address

2401 OAK DR
ANCHORAGE AK
99508-3267
US

V. Phone/Fax

Practice location:
  • Phone: 907-278-0308
  • Fax: 907-278-0408
Mailing address:
  • Phone: 907-278-0308
  • Fax: 907-278-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number738560
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberRL5743
License Number StateAK

VIII. Authorized Official

Name: MRS. WILMA ERIBAL TANNER
Title or Position: ADMINISTRATOR, OWNER
Credential: LPN
Phone: 907-441-9595