Provider Demographics
NPI:1154137503
Name:DEAF ALASKA ASSISTED LIVING HOME
Entity type:Organization
Organization Name:DEAF ALASKA ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:MAED
Authorized Official - Phone:907-268-3140
Mailing Address - Street 1:PO BOX 222504
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-2504
Mailing Address - Country:US
Mailing Address - Phone:907-268-3140
Mailing Address - Fax:
Practice Address - Street 1:7301 MEADOW ST APT B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2692
Practice Address - Country:US
Practice Address - Phone:907-268-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care