MEDICARE: CASA BELLA ASSISTED LIVING HOME, LLC.

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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1104446418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASA BELLA ASSISTED LIVING HOME, LLC.

Provider Business Mailing Address
First Line	:	7740 KING ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99518-3054
Country	:	US
Telephone Number	:	907-727-6092
Fax Number	:

Provider Business Practice Location Address
First Line	:	2630 KINGSBRIDGE CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-3366
Country	:	US
Telephone Number	:	907-727-6092
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	KATHERINE GLADYS FOREST
Credential	:
Telephone Number	:	907-727-6092

Provider Enumeration Date	:	04/17/2020
Last Update Date	:	04/17/2020

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