MEDICARE: FIREWEED ASSISTED LIVING

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	3104A0630X	Assisted Living Facility (Behavioral Disturbances)

General Provider Information

NPI Number	:	1609472513
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIREWEED ASSISTED LIVING

Provider Business Mailing Address
First Line	:	3140 DE ARMOUN RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-3535
Country	:	US
Telephone Number	:	907-575-0508
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 DE ARMOUN RD
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99516-3636
Country	:	US
Telephone Number	:	907-575-0508
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	BETSY DEE BALTS
Credential	:
Telephone Number	:	907-575-0508

Provider Enumeration Date	:	12/07/2020
Last Update Date	:	08/24/2021

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Directions to “FIREWEED ASSISTED LIVING ” Practice Location

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