Healthcare Provider Details

I. General information

NPI: 1639247810
Provider Name (Legal Business Name): NORTHERN LIVING CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2795 W STONEBRIDGE DR
WASILLA AK
99654-0742
US

IV. Provider business mailing address

3310 W. RIVERDELL DR.
WASILLA AK
99654-9704
US

V. Phone/Fax

Practice location:
  • Phone: 907-376-3821
  • Fax:
Mailing address:
  • Phone: 907-376-3821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number723017
License Number StateAK

VIII. Authorized Official

Name: KAREN L RHOADES
Title or Position: OWNER
Credential:
Phone: 907-376-3821