MEDICARE: ANCHOR' CARE 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	100672	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100672	OTHER	AK	ASSISTED LIVING HOME LICENSE
2	908091	OTHER	AK	AK BUSINESS LICENSE

General Provider Information

NPI Number	:	1396907507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCHOR' CARE ASSISTED LIVING HOME

Provider Business Mailing Address
First Line	:	5225 E 22ND AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-3705
Country	:	US
Telephone Number	:	907-332-0514
Fax Number	:	907-332-0514

Provider Business Practice Location Address
First Line	:	5225 E 22ND AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-3705
Country	:	US
Telephone Number	:	907-332-0514
Fax Number	:	907-332-0514

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. NELSON H ANIEL
Credential	:
Telephone Number	:	907-332-0514

Provider Enumeration Date	:	06/28/2008
Last Update Date	:	06/28/2008

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Directions to “ANCHOR' CARE ASSISTED LIVING HOME ” Practice Location

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