Provider Demographics
NPI:1336754969
Name:SNOW CITY ASSISTED LIVING HOME, LLC
Entity Type:Organization
Organization Name:SNOW CITY ASSISTED LIVING HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINELLE
Authorized Official - Middle Name:DIAMANTE
Authorized Official - Last Name:MANTOJAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-406-5640
Mailing Address - Street 1:2634 CARROLL PL UNIT B
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3821
Mailing Address - Country:US
Mailing Address - Phone:907-406-5640
Mailing Address - Fax:907-339-2344
Practice Address - Street 1:2634 CARROLL PL UNIT B
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3821
Practice Address - Country:US
Practice Address - Phone:907-406-5640
Practice Address - Fax:907-339-2344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility