Provider Demographics
NPI:1982976437
Name:APHRODITE ASSISTED LIVING HOME INC.
Entity type:Organization
Organization Name:APHRODITE ASSISTED LIVING HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSIE
Authorized Official - Middle Name:JOB
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-230-8486
Mailing Address - Street 1:PO BOX 92393
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99509-2393
Mailing Address - Country:US
Mailing Address - Phone:907-344-9442
Mailing Address - Fax:907-868-1599
Practice Address - Street 1:4009 SCENIC VIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6603
Practice Address - Country:US
Practice Address - Phone:907-770-5777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100548310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL16452Medicaid