Provider Demographics
NPI:1386844355
Name:TWIN HEARTS ALE
Entity type:Organization
Organization Name:TWIN HEARTS ALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ILUMINADA
Authorized Official - Middle Name:PUNO
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-339-9328
Mailing Address - Street 1:1111 BOSTON STREET
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-2015
Mailing Address - Country:US
Mailing Address - Phone:907-339-9328
Mailing Address - Fax:907-770-6019
Practice Address - Street 1:1111 BOSTON ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-2015
Practice Address - Country:US
Practice Address - Phone:907-339-9328
Practice Address - Fax:907-770-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100593320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities