Healthcare Provider Details

I. General information

NPI: 1932663820
Provider Name (Legal Business Name): 3 ANGELS' ASSISTED LIVING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2019
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 GARDEN ST
ANCHORAGE AK
99508-2937
US

IV. Provider business mailing address

2937 MORGAN LOOP
ANCHORAGE AK
99516-1427
US

V. Phone/Fax

Practice location:
  • Phone: 907-350-9715
  • Fax:
Mailing address:
  • Phone: 907-350-9715
  • 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: JAKE MASLOFF
Title or Position: OWNER
Credential:
Phone: 907-350-9715