Healthcare Provider Details

I. General information

NPI: 1073390043
Provider Name (Legal Business Name): NAATH ASSISTEDNLIVING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W 29TH PL
ANCHORAGE AK
99503-3746
US

IV. Provider business mailing address

1104 W 29TH PL
ANCHORAGE AK
99503-3746
US

V. Phone/Fax

Practice location:
  • Phone: 907-222-6775
  • Fax:
Mailing address:
  • Phone: 907-222-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JAMES K PUOL
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-222-6775