Organization
LIFETOTHEFULLESTLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW JESELNIK (OWNER/ADMINISTRATOR)
(907) 317-1093
Entity
Organization
Contact information
Practice address
1233 5TH AVE, FAIRBANKS, AK 99701-4211
(907) 317-1093
Mailing address
1233 5TH AVE, FAIRBANKS, AK 99701-4211
(907) 317-1093
Taxonomy
Speciality
Code
Description
License number
State
3104A0625X
Assisted Living Facility (Mental Illness)
Primary
101139
AK
Other
Enumeration date
12/12/2016
Last updated
12/12/2016
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