Organization
TASI ALH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAN REYES (MEMBER)
(808) 492-9088
Entity
Organization
Contact information
Practice address
2812 W 29TH AVE, ANCHORAGE, AK 99517-1701
(907) 313-4097
Mailing address
4221 EAU CLAIRE PL APT 3, ANCHORAGE, AK 99508-5170
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
101423
STATE OF ALASKA ASSISTED LIVING LICENSE
AK
Enumeration date
11/30/2020
Last updated
11/30/2020
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