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General NPI Number Information
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NPI Number | 1659009272
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Entity Type | Organization
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Legal Business Name | FAIRBANKS ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 08/11/2022
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Provider Practice Location Address
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Address Line | 164 SYRACUSE CT APT 1
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City | FAIRBANKS
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State | AK
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Zip | 99709-2977
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Country | US
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Telephone | 907-987-0304
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Fax |
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Provider Business Mailing Address
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Address Line | 114 CAHABA ST
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City | ENTERPRISE
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State | AL
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Zip | 36330-3627
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Country | US
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Telephone | 907-888-5163
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DIANA MARGALEEN MHURIRO
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Credential | RN
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Telephone | 907-888-5163
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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