Victory Assisted Living Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

100911 Issued in AK

Legal business name

VICTORY ASSISTED LIVING HOME

Practice address

9321 Aphrodite Dr
Anchorage,Alaska
Anchorage, AK 99515-1493

Phone

(907) 301-4697

NPI assigned

May 16, 2012

Organization subpart

No

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

Authorized official

Name

Macristina Nitiprawoto

Title

Administrator

Phone

(907) 301-4697

Specialties & licenses 3

Addresses

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

{
    "created_epoch": "1337126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337126400000",
    "number": "1902166556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9321 APHRODITE DR",
            "address_2": "ANCHORAGE,ALASKA",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995151493",
            "telephone_number": "907-301-4697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9321 APHRODITE DR",
            "address_2": "ANCHORAGE,ALASKA",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995151493",
            "telephone_number": "907-301-4697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY ASSISTED LIVING HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-16",
        "last_updated": "2012-05-16",
        "status": "A",
        "authorized_official_last_name": "NITIPRAWOTO",
        "authorized_official_first_name": "MACRISTINA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-301-4697"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "100911",
            "primary": true
        },
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3104A0630X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Behavioral Disturbances",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2012; 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.