MEDICARE: GENEVIEVE 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		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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346367265
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GENEVIEVE ASSISTED LIVING HOME

Provider Business Mailing Address
First Line	:	3627 RANDOLPH ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4526
Country	:	US
Telephone Number	:	907-561-7529
Fax Number	:	907-222-2419

Provider Business Practice Location Address
First Line	:	1922 LOGAN ST
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-3281
Country	:	US
Telephone Number	:	907-222-1980
Fax Number	:	907-222-2419

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EVELYN G. MINA
Credential	:	R.N.
Telephone Number	:	907-230-0876

Provider Enumeration Date	:	03/24/2007
Last Update Date	:	08/22/2020

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