Basic Information
| Provider Information | |||||||||
| NPI: | 1326597410 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENALI CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1510 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997015900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074585525 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1510 19TH AVE | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997015900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074585525 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2016 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | LESLIE | ||||||||
| AuthorizedOfficialFirstName: | STEPHEN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 9074583310 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | FOUNDATION HEALTH, LLC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.