Healthcare Provider Details

I. General information

NPI: 1124957303
Provider Name (Legal Business Name): KONVALIA ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7310 BULEN DR
ANCHORAGE AK
99507-2881
US

IV. Provider business mailing address

PO BOX 231166
ANCHORAGE AK
99523-1166
US

V. Phone/Fax

Practice location:
  • Phone: 907-339-1522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ALLA LUSHCHYK
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-339-1522