Provider Demographics
NPI:1437507423
Name:ANDREW & PATRICIA WEISS, LLC
Entity Type:Organization
Organization Name:ANDREW & PATRICIA WEISS, LLC
Other - Org Name:GLACIER ALH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-440-2410
Mailing Address - Street 1:PO BOX 241934
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1934
Mailing Address - Country:US
Mailing Address - Phone:907-440-2410
Mailing Address - Fax:
Practice Address - Street 1:1139 RIL CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1621
Practice Address - Country:US
Practice Address - Phone:907-440-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101126310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility