# MISTY GLEN ASSISTED LIVING LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699438010
- **Authorized official:** JESSICA FULTON (OWNER)
- **Authorized official phone:** (907) 306-4173

## Contact information

- **Practice address:** 2120 MISTY GLEN CIR, ANCHORAGE, AK 99502-4643
- **Practice address phone:** (907) 306-4173
- **Mailing address:** 400 W 76TH AVE APT 105, ANCHORAGE, AK 99518-2551
- **Mailing address phone:** (907) 306-4173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 10/21/2021
- **Last updated:** 10/21/2021