Healthcare Provider Details

I. General information

NPI: 1881354132
Provider Name (Legal Business Name): FORAYS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N LAGOON DR
WASILLA AK
99654-9353
US

IV. Provider business mailing address

2800 N LAGOON DR
WASILLA AK
99654-9353
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-6493
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRAD ANDERSON
Title or Position: OWNER
Credential:
Phone: 706-267-4433