Provider Demographics
NPI:1447438098
Name:ARCTIC HAVEN OF OKLAHOMA ALH
Entity type:Organization
Organization Name:ARCTIC HAVEN OF OKLAHOMA ALH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MYLEINEGESELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:BSN,LPN
Authorized Official - Phone:907-229-9457
Mailing Address - Street 1:250 OKLAHOMA ST # 2
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1342
Mailing Address - Country:US
Mailing Address - Phone:907-229-9457
Mailing Address - Fax:
Practice Address - Street 1:250 OKLAHOMA ST # 2
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1342
Practice Address - Country:US
Practice Address - Phone:907-229-9457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100564310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility