Provider Demographics
NPI:1649739640
Name:M&M ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:M&M ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MERCY
Authorized Official - Middle Name:GUILLEMA
Authorized Official - Last Name:SONZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-317-3926
Mailing Address - Street 1:7522 GREY WOLF CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-4803
Mailing Address - Country:US
Mailing Address - Phone:907-317-3926
Mailing Address - Fax:907-274-0903
Practice Address - Street 1:7522 GREY WOLF CIR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-4803
Practice Address - Country:US
Practice Address - Phone:907-317-3926
Practice Address - Fax:907-274-0903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities