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General NPI Number Information
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NPI Number | 1972472017
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Entity Type | Organization
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Legal Business Name | JEWEL LAKE ASSISTED LIVING HOME LLC
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Dates
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Enumeration Date | 11/04/2025
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 4132 W 88TH AVE
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City | ANCHORAGE
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State | AK
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Zip | 99502-5107
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Country | US
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Telephone | 907-250-4732
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Fax | 907-245-0035
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Provider Business Mailing Address
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Address Line | 4132 W 88TH AVE
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City | ANCHORAGE
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State | AK
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Zip | 99502-5107
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Country | US
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Telephone | 907-250-4732
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Fax | 907-245-0035
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | EMELYN YOUNG
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Credential | LPN
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Telephone | 907-250-4732
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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