Active NPI
Kodiak Island Assisted Living, LLC
- Developmentally Disabled Services Day Training Agency
- Kodiak, AK
National Provider Identifier
1063259687
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmentally Disabled Services Day Training Agency
- Legal business name
- KODIAK ISLAND ASSISTED LIVING, LLC
- Practice address
- 1814 Simeonof St
Kodiak, AK 99615-6517 - Phone
- (915) 841-1117
- NPI assigned
- Jul 11, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mary Jean V Silva, PHD
- Title
- Adminstrator
- Phone
- (915) 841-1117
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmentally Disabled Services Day Training Agency | 251C00000X | Primary | ||
| In Home Supportive Care Agency | 253Z00000X |
Addresses
Primary practice location
1814 Simeonof St
Kodiak, AK 99615-6517
Mailing address
914 Thorsheim St
Kodiak, AK 99615-6165
Phone (915) 841-1117
National Provider Directory
National Provider Directory- Tax ID family
- Kodiak Island Assisted Living LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Assisted Living Facility (Mental Illness)
- Kodiak, AK
- NPI 1093538456
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720656000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1720656000000",
"number": "1063259687",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "914 THORSHEIM ST",
"city": "KODIAK",
"state": "AK",
"postal_code": "996156165",
"telephone_number": "915-841-1117"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1814 SIMEONOF ST",
"city": "KODIAK",
"state": "AK",
"postal_code": "996156517",
"telephone_number": "915-841-1117"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KODIAK ISLAND ASSISTED LIVING, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-07-11",
"last_updated": "2024-07-11",
"certification_date": "2024-07-10",
"status": "A",
"authorized_official_last_name": "SILVA",
"authorized_official_first_name": "MARY JEAN",
"authorized_official_middle_name": "V",
"authorized_official_title_or_position": "ADMINSTRATOR",
"authorized_official_telephone_number": "915-841-1117",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "PHD"
},
"taxonomies": [
{
"code": "251C00000X",
"taxonomy_group": "",
"desc": "Day Training, Developmentally Disabled Services",
"state": null,
"license": null,
"primary": true
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kodiak, AK
- Kodiak Birth and Wellness, LLC
- Kodiak Board Certified Radiology, LLC
- Kodiak Cubs Speech
- Kodiak Diagnostic Imaging, Professional Corporation
- Kodiak Island Ambulatory Care Clinic Inc.
- Kodiak Island Assisted Living, LLC
- Kodiak Island Family Dentistry
- Kodiak Island Health Care Foundation (Kodiak Community Health Center)
- Kodiak Island Health Care Foundation (Kodiak Community Health Center Pharmacy)
- Kodiak Island Medical Associates LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.