Healthcare Provider Details

I. General information

NPI: 1033702881
Provider Name (Legal Business Name): FAMILY CARE ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 W 79TH AVE
ANCHORAGE AK
99502-4406
US

IV. Provider business mailing address

2221 W 46TH AVE
ANCHORAGE AK
99517-3162
US

V. Phone/Fax

Practice location:
  • Phone: 907-306-9776
  • Fax:
Mailing address:
  • Phone: 907-306-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State

VIII. Authorized Official

Name: MENIME SEGA
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 907-306-9776