Healthcare Provider Details

I. General information

NPI: 1164016580
Provider Name (Legal Business Name): LANIE ORRINE YOUNG ADMINISTRATOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 03/26/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 ROOSEVELT DRIVE
ANCHORAGE AK
99517
US

IV. Provider business mailing address

2209 MCKINLEY AVE
ANCHORAGE AK
99517-3018
US

V. Phone/Fax

Practice location:
  • Phone: 907-317-8512
  • Fax:
Mailing address:
  • Phone: 907-317-8512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376G00000X
TaxonomyNursing Home Administrator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: