Healthcare Provider Details

I. General information

NPI: 1154137503
Provider Name (Legal Business Name): DEAF ALASKA ASSISTED LIVING HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MEADOW ST APT B
ANCHORAGE AK
99507-2692
US

IV. Provider business mailing address

PO BOX 222504
ANCHORAGE AK
99522-2504
US

V. Phone/Fax

Practice location:
  • Phone: 907-268-3140
  • Fax:
Mailing address:
  • Phone: 907-268-3140
  • 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 State
# 2
Primary TaxonomyN
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. SEAN PATRICK GORDON
Title or Position: ADMINISTRATOR
Credential: MAED
Phone: 907-268-3140