MEDICARE: JEWEL LAKE 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	376G00000X	Nursing Home Administrator

General Provider Information

NPI Number	:	1972472017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWEL LAKE ASSISTED LIVING HOME LLC

Provider Business Mailing Address
First Line	:	4132 W 88TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-5107
Country	:	US
Telephone Number	:	907-250-4732
Fax Number	:	907-245-0035

Provider Business Practice Location Address
First Line	:	4132 W 88TH AVE
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-5107
Country	:	US
Telephone Number	:	907-250-4732
Fax Number	:	907-245-0035

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	EMELYN YOUNG
Credential	:	LPN
Telephone Number	:	907-250-4732

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	11/04/2025

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