Provider Demographics
NPI:1689935777
Name:DAN & ROBIN MINGO ENTERPRISES
Entity Type:Organization
Organization Name:DAN & ROBIN MINGO ENTERPRISES
Other - Org Name:NONE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MINGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-715-7284
Mailing Address - Street 1:602 N MORIAH CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-0889
Mailing Address - Country:US
Mailing Address - Phone:907-715-7284
Mailing Address - Fax:907-376-7215
Practice Address - Street 1:7750 W GOLDEN DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-9235
Practice Address - Country:US
Practice Address - Phone:907-373-7740
Practice Address - Fax:907-376-7215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100933310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility