Provider Demographics
NPI:1730689522
Name:FITCHETT'S ASSISTED LIVING HOME LLC
Entity type:Organization
Organization Name:FITCHETT'S ASSISTED LIVING HOME LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:FITCHETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-242-9698
Mailing Address - Street 1:8481 RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4196
Mailing Address - Country:US
Mailing Address - Phone:907-242-9698
Mailing Address - Fax:
Practice Address - Street 1:8481 RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4196
Practice Address - Country:US
Practice Address - Phone:907-242-9698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-18
Last Update Date:2018-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1063205310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPENDINGMedicaid