Provider Demographics
NPI:1376273169
Name:MAGNOLIA MANOR ALH
Entity Type:Organization
Organization Name:MAGNOLIA MANOR ALH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-841-6471
Mailing Address - Street 1:3296 E TRAVIS LN
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-0422
Mailing Address - Country:US
Mailing Address - Phone:907-841-6471
Mailing Address - Fax:
Practice Address - Street 1:751 N SOMERET CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-6380
Practice Address - Country:US
Practice Address - Phone:907-841-6471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility