| Organization Name: | SUE'S SOURDOUGH ASSISTED LIVING |
| NPI Number: | 1023233533 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUSAN CRESS (DIRECT OWNER) |
| Mailing Address: | 14650 Park Hills Dr Anchorage |
| State: | AK US |
| Postal Code: | 995164241 |
| Phone Number: | 9073451854 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 100415 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |