Provider Demographics
NPI:1538688619
Name:DASH ENTERPRISES
Entity Type:Organization
Organization Name:DASH ENTERPRISES
Other - Org Name:HARBOR HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-305-0500
Mailing Address - Street 1:PO BOX 2333
Mailing Address - Street 2:
Mailing Address - City:WRANGELL
Mailing Address - State:AK
Mailing Address - Zip Code:99929-2333
Mailing Address - Country:US
Mailing Address - Phone:907-874-4580
Mailing Address - Fax:
Practice Address - Street 1:1104 PENINSULA STREET
Practice Address - Street 2:
Practice Address - City:WRANGELL
Practice Address - State:AK
Practice Address - Zip Code:99929
Practice Address - Country:US
Practice Address - Phone:907-874-4580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101239310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility