Provider Demographics
NPI:1447640560
Name:GOLDEN FRIENDSHIP HOME FOR ELDERLY
Entity type:Organization
Organization Name:GOLDEN FRIENDSHIP HOME FOR ELDERLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-903-9552
Mailing Address - Street 1:9180 APHRODITE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1499
Mailing Address - Country:US
Mailing Address - Phone:907-248-5276
Mailing Address - Fax:907-245-2782
Practice Address - Street 1:9180 APHRODITE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1499
Practice Address - Country:US
Practice Address - Phone:907-903-8552
Practice Address - Fax:907-248-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100943261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRLXMedicaid