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General NPI Number Information
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NPI Number | 1558679274
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Entity Type | Organization
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Legal Business Name | COPPER RIVER CARE ASSISTED LIVING HOME
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Dates
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Enumeration Date | 09/15/2010
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 3/4 MILE RIDGE ROAD
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City | SALANA
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State | AK
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Zip | 99586
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Country | US
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Telephone | 907-822-4255
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 866 3/4 MILE RIDGE ROAD
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City | SALANA
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State | AK
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Zip | 99586
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Country | US
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Telephone | 907-822-4255
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANGELIA RAY WEBB
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Credential | RN
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Telephone | 907-822-4255
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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 | 921585
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License Number State | AK
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