Provider Demographics
NPI:1730481219
Name:MAILE ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:MAILE ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRESENCIA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-222-7541
Mailing Address - Street 1:6920 PECK AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-1160
Mailing Address - Country:US
Mailing Address - Phone:907-222-7541
Mailing Address - Fax:
Practice Address - Street 1:6920 PECK AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1160
Practice Address - Country:US
Practice Address - Phone:907-222-7541
Practice Address - Fax:907-222-7541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100808310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility