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General NPI Number Information
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NPI Number | 1215061205
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Entity Type | Organization
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Legal Business Name | NORTHSTAR ASSISTED LIVING, INC.
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4070 S BIRCH COVE DR
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City | WASILLA
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State | AK
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Zip | 99654-9456
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Country | US
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Telephone | 907-357-2019
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 872889
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City | WASILLA
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State | AK
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Zip | 99687-2889
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Country | US
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Telephone | 907-357-2019
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER, PRESIDENT CEO
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Name | MR. MICHAEL ALLEN HERVEY
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Credential |
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Telephone | 907-357-2012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 000093
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License Number State | AK
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