Provider Demographics
NPI:1124554183
Name:SCENIC MANOR ASSISTED LIVING HOMES
Entity Type:Organization
Organization Name:SCENIC MANOR ASSISTED LIVING HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:ROMERO
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:971-269-9382
Mailing Address - Street 1:4009 SCENIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504
Mailing Address - Country:US
Mailing Address - Phone:907-770-5777
Mailing Address - Fax:907-770-5777
Practice Address - Street 1:4009 SCENIC VIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-6603
Practice Address - Country:US
Practice Address - Phone:907-770-5777
Practice Address - Fax:907-770-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101215310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK=========Medicaid