Healthcare Provider Details

I. General information

NPI: 1295581981
Provider Name (Legal Business Name): ANGEL OF HOPE ASSISTED LIVING HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2024
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11210 WILLENE DR
ANCHORAGE AK
99516-1386
US

IV. Provider business mailing address

11210 WILLENE DR
ANCHORAGE AK
99516-1386
US

V. Phone/Fax

Practice location:
  • Phone: 907-539-2871
  • Fax:
Mailing address:
  • Phone: 907-539-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MICHELLE HERMOSURA FABRO
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-359-2871