Organization
GRANDMA K'S PLACE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS THELMA JEAN DUBYAK (OWNER ADMINISTRATOR)
(907) 522-1958
Entity
Organization
Contact information
Practice address
3832 YOUNG ST, ANCHORAGE, AK 99508-4548
(907) 522-1958
Mailing address
3832 YOUNG ST, ANCHORAGE, AK 99508-4548
(907) 522-1958
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
000287
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RL19691
—
AK
Enumeration date
05/18/2007
Last updated
08/22/2020
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