Provider Demographics
NPI:1689130189
Name:MAPLE SPRINGS OF WASILLA SNF HOLDINGS LLC
Entity Type:Organization
Organization Name:MAPLE SPRINGS OF WASILLA SNF HOLDINGS LLC
Other - Org Name:MAPLE SPRINGS OF WASILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:CLAY
Authorized Official - Last Name:DAHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-841-1217
Mailing Address - Street 1:3265 E MERIDIAN PARK LOOP
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7474
Mailing Address - Country:US
Mailing Address - Phone:907-841-1217
Mailing Address - Fax:907-373-1820
Practice Address - Street 1:3265 E MERIDIAN PARK LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7474
Practice Address - Country:US
Practice Address - Phone:907-841-1217
Practice Address - Fax:907-373-1820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-20
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251J00000XAgenciesNursing Care