MEDICARE: NAATH ASSISTEDNLIVING HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320800000X	Mental Illness Community Based Residential Treatment Facility
2	3104A0625X	Assisted Living Facility (Mental Illness)

General Provider Information

NPI Number	:	1073390043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NAATH ASSISTEDNLIVING HOME

Provider Business Mailing Address
First Line	:	1104 W 29TH PL
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3746
Country	:	US
Telephone Number	:	907-222-6775
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 W 29TH PL
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99503-3746
Country	:	US
Telephone Number	:	907-222-6775
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JAMES K PUOL
Credential	:
Telephone Number	:	907-222-6775

Provider Enumeration Date	:	09/12/2023
Last Update Date	:	09/12/2023

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Directions to “NAATH ASSISTEDNLIVING HOME ” Practice Location

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