Organization
COUNTRY ESTATES INC
Active
Organization
COUNTRY ESTATES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUDITH JACHIM (ADMINISTRATOR)
(907) 457-3594
Entity
Organization
Contact information
Practice address
240 PEREGRINE DRIVE, FAIRBANKS, AK 99712
(907) 457-3594
Mailing address
PO BOX 10069, FAIRBANKS, AK 99710-0069
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
000222
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RL68071
—
AK
Enumeration date
05/17/2007
Last updated
08/22/2020
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