Provider Demographics
NPI:1922446590
Name:NIDA HARRIS, MARGIE L (OWNER)
Entity Type:Individual
Prefix:
First Name:MARGIE
Middle Name:L
Last Name:NIDA HARRIS
Suffix:
Gender:F
Credentials:OWNER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 211042
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99521
Mailing Address - Country:US
Mailing Address - Phone:907-301-2940
Mailing Address - Fax:907-333-3007
Practice Address - Street 1:5340 CARIBOU AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508
Practice Address - Country:US
Practice Address - Phone:907-301-2940
Practice Address - Fax:907-333-3007
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility