Organization
VICTORY ASSISTED LIVING HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MACRISTINA NITIPRAWOTO (ADMINISTRATOR)
(907) 301-4697
Entity
Organization
Contact information
Practice address
9321 APHRODITE DR, ANCHORAGE,ALASKA, ANCHORAGE, AK 99515-1493
(907) 301-4697
Mailing address
9321 APHRODITE DR, ANCHORAGE,ALASKA, ANCHORAGE, AK 99515-1493
(907) 301-4697
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
100911
AK
3104A0625X
Assisted Living Facility (Mental Illness)
—
—
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
—
Other
Enumeration date
05/16/2012
Last updated
05/16/2012
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