Provider Demographics
NPI:1053443127
Name:THE MANOR LLC
Entity Type:Organization
Organization Name:THE MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:DALHAUG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-247-8748
Mailing Address - Street 1:250 HECKMAN ST
Mailing Address - Street 2:PO BOX 8163
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5511
Mailing Address - Country:US
Mailing Address - Phone:907-247-8748
Mailing Address - Fax:907-247-8747
Practice Address - Street 1:250 HECKMAN ST
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5511
Practice Address - Country:US
Practice Address - Phone:907-247-8748
Practice Address - Fax:907-247-8747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL8080Medicaid