Kodiak Island Assisted Living, LLC

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

KODIAK ISLAND ASSISTED LIVING, LLC

Doing business as

Kodiak Island Assisted Living, LLC

Practice address

1814 Simeonof St
Kodiak, AK 99615-6517

Phone

(915) 841-1117

NPI assigned

Nov 4, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Mary Jean V Silva

Title

Administrator

Phone

(915) 841-1117

Specialties & licenses 2

Addresses

Other names 1

• Kodiak Island Assisted Living, LLC Doing business as

Tax ID family

Kodiak Island Assisted Living LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Kodiak Island Assisted Living, LLC

  • Developmentally Disabled Services Day Training Agency
  • Kodiak, AK
  • NPI 1063259687
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1093538456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1814 SIMEONOF ST",
            "city": "KODIAK",
            "state": "AK",
            "postal_code": "996156517",
            "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": "2024-11-04",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "SILVA",
        "authorized_official_first_name": "MARY JEAN",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "915-841-1117",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kodiak Island Assisted Living, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• 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
• Kodiak Island Medical Associates LLC

• Assisted Living Facility (Mental Illness) in Kodiak, AK
• Providers in Kodiak, AK by specialty
• Assisted Living Facility (Mental Illness) in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.

Verify at the official NPI Registry.