MEDICARE: COMPASSIONATE CARE 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	310400000X	Assisted Living Facility	100442	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

General Provider Information

NPI Number	:	1689899494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPASSIONATE CARE ASSISTED LIVING

Provider Business Mailing Address
First Line	:	235 ALASKA PL
Second Line	:	UNIT B
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-1317
Country	:	US
Telephone Number	:	907-339-9929
Fax Number	:	907-339-9609

Provider Business Practice Location Address
First Line	:	235 ALASKA PL
Second Line	:	UNIT B
City	:	ANCHORAGE
State	:	AK
Zip	:	99504-1317
Country	:	US
Telephone Number	:	907-339-9929
Fax Number	:	907-339-9609

Authorized Official
Title or Position	:	OWNER ADMINISTATOR
Name	:	MRS. BRENDA LEE HUMBLE
Credential	:	C.N.A
Telephone Number	:	907-339-9929

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	06/16/2008

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Directions to “COMPASSIONATE CARE ASSISTED LIVING ” Practice Location

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