Healthcare Provider Details

I. General information

NPI: 1902022262
Provider Name (Legal Business Name): HARBOR LIGHTS HOUSE ASSISTED LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 08/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39355 DUDLEY AVE
SOLDOTNA AK
99669-8603
US

IV. Provider business mailing address

39355 DUDLEY AVE
SOLDOTNA AK
99669-8603
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-5355
  • Fax:
Mailing address:
  • Phone: 907-262-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number249
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number000249
License Number StateAK

VIII. Authorized Official

Name: JOANNE L REED
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-262-5355