Provider Demographics
NPI:1366987000
Name:BENEDICT ASSISTED LIVING HOME, LLC
Entity type:Organization
Organization Name:BENEDICT ASSISTED LIVING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DESIGNEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA LIZA
Authorized Official - Middle Name:NARANJO
Authorized Official - Last Name:CADAVOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-350-0978
Mailing Address - Street 1:3511 ALAMOSA DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-5222
Mailing Address - Country:US
Mailing Address - Phone:907-350-0978
Mailing Address - Fax:907-865-2464
Practice Address - Street 1:3511 ALAMOSA DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-5222
Practice Address - Country:US
Practice Address - Phone:907-350-0978
Practice Address - Fax:907-865-2464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1039375320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities