MEDICARE: AIDING ANGELS ASSISTED LIVING 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	310400000X	Assisted Living Facility	717746	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114085057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIDING ANGELS ASSISTED LIVING HOME

Provider Business Mailing Address
First Line	:	5149 SILLARY CIRCLE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508
Country	:	US
Telephone Number	:	907-338-5747
Fax Number	:	907-338-2592

Provider Business Practice Location Address
First Line	:	5149 SILLARY CIRCLE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508
Country	:	US
Telephone Number	:	907-338-5747
Fax Number	:	907-338-2592

Authorized Official
Title or Position	:	ADMINISTRATOR CO OWNER
Name	:	MR. GARY LEE MADRID
Credential	:
Telephone Number	:	907-338-5747

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/09/2008

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Directions to “AIDING ANGELS ASSISTED LIVING HOME ” Practice Location

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