Healthcare Provider Details

I. General information

NPI: 1982254009
Provider Name (Legal Business Name): ARCTIC ROSE ASSISTED LIVING FACILITY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5291 N HONEYSUCKLE LN
WASILLA AK
99654-1400
US

IV. Provider business mailing address

5291 N HONEYSUCKLE LN
WASILLA AK
99654-1400
US

V. Phone/Fax

Practice location:
  • Phone: 907-917-4168
  • Fax: 855-487-3308
Mailing address:
  • Phone: 907-917-4168
  • Fax: 855-487-3308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. ELISA V WINCHESTER
Title or Position: ADMINISTRATOR
Credential: LPN
Phone: 907-917-4168