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General NPI Number Information
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NPI Number | 1801371927
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Entity Type | Organization
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Legal Business Name | SKYLINE ASSISTED LIVING HOME LLC
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 09/25/2018
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Provider Practice Location Address
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Address Line | 63540 SKYLINE DR
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City | HOMER
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State | AK
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Zip | 99603-9333
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Country | US
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Telephone | 907-266-2266
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Fax | 907-226-2265
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Provider Business Mailing Address
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Address Line | 63540 SKYLINE DR
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City | HOMER
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State | AK
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Zip | 99603-9333
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Country | US
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Telephone | 907-266-2266
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Fax | 907-226-2265
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. DALE FRANKLYN OTCHECK
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Credential |
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Telephone | 907-598-1992
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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 |
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License Number State |
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