Provider Demographics
NPI:1063702546
Name:ABRA ASSISTED LIVING HOME
Entity type:Organization
Organization Name:ABRA ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINITRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:MERLO
Authorized Official - Middle Name:ISANG
Authorized Official - Last Name:LLANEZA
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:907-522-0564
Mailing Address - Street 1:1609 BETULA CIRCCLE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4126
Mailing Address - Country:US
Mailing Address - Phone:907-522-0564
Mailing Address - Fax:907-929-7793
Practice Address - Street 1:1609 BETULA CIR
Practice Address - Street 2:CIR
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4126
Practice Address - Country:US
Practice Address - Phone:907-522-0564
Practice Address - Fax:907-929-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100875320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities