MEDICARE: KINDLY 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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1184274755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDLY ASSISTED LIVING HOME, LLC

Provider Business Mailing Address
First Line	:	5420 AVILA CT
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4963
Country	:	US
Telephone Number	:	907-782-9198
Fax Number	:

Provider Business Practice Location Address
First Line	:	5420 AVILA CT
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4963
Country	:	US
Telephone Number	:	907-782-9198
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DENISE CARINO
Credential	:
Telephone Number	:	907-782-9198

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	09/16/2019

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