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General NPI Number Information
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NPI Number | 1467887349
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Entity Type | Organization
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Legal Business Name | RIVERSIDE ASSISTED LIVING SOLDOTNA, INC.
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Dates
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Enumeration Date | 09/10/2013
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 390 LOVERS LN
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City | SOLDOTNA
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State | AK
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Zip | 99669-7946
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Country | US
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Telephone | 907-398-5513
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Fax |
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Provider Business Mailing Address
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Address Line | 390 LOVERS LN
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City | SOLDOTNA
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State | AK
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Zip | 99669-7946
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | CORY CASTAGNETO
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Credential |
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Telephone | 907-398-5513
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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 | 101025
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License Number State | AK
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