Healthcare Provider Details

I. General information

NPI: 1972443810
Provider Name (Legal Business Name): GOLDEN ANGEL ASSISTED LIVING HOME LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6647 E 16TH AVE
ANCHORAGE AK
99504-2510
US

IV. Provider business mailing address

6647 E 16TH AVE
ANCHORAGE AK
99504-2510
US

V. Phone/Fax

Practice location:
  • Phone: 907-300-9381
  • Fax:
Mailing address:
  • Phone: 907-300-9381
  • 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 Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: FEBBIE SHANE DIMALANTA
Title or Position: OWNER
Credential:
Phone: 907-300-9381