Healthcare Provider Details

I. General information

NPI: 1083332985
Provider Name (Legal Business Name): ELIJAS ASSISTED LIVING HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 08/16/2022
Certification Date: 08/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 OCEANVIEW DR
ANCHORAGE AK
99515-3906
US

IV. Provider business mailing address

1175 OCEANVIEW DR
ANCHORAGE AK
99515-3906
US

V. Phone/Fax

Practice location:
  • Phone: 907-802-0380
  • Fax:
Mailing address:
  • Phone: 907-802-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEPHEN AIKEY
Title or Position: ADMINISTRATOR MANAGER
Credential:
Phone: 907-802-0380