NPIMap

Organization Active NPI

Lifetothefullestllc

  • Assisted Living Facility (Mental Illness)
  • Fairbanks, AK
National Provider Identifier
1245774108
Registry record updated Dec 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
License
101139 Issued in AK
Legal business name
LIFETOTHEFULLESTLLC
Practice address
1233 5TH Ave
Fairbanks, AK 99701-4211
Phone
(907) 317-1093
NPI assigned
Dec 12, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2016

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

Authorized official

Name
Matthew JeselnikNPI 1386188720
Title
Owner/Administrator
Phone
(907) 317-1093

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X 101139 AK Primary

Addresses

Primary practice location

1233 5TH Ave
Fairbanks, AK 99701-4211

Mailing address

1233 5TH Ave
Fairbanks, AK 99701-4211
Phone (907) 317-1093

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1481500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481500800000",
    "number": "1245774108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 5TH AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014211",
            "telephone_number": "907-317-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1233 5TH AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014211",
            "telephone_number": "907-317-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFETOTHEFULLESTLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-12",
        "last_updated": "2016-12-12",
        "status": "A",
        "authorized_official_last_name": "JESELNIK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER/ADMINISTRATOR",
        "authorized_official_telephone_number": "907-317-1093"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "AK",
            "license": "101139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2016; 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.