Provider Demographics
NPI:1831399203
Name:BALD MOUNTAIN VIEW ASSISTED LIVING HOME
Entity type:Organization
Organization Name:BALD MOUNTAIN VIEW ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHURMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-373-5801
Mailing Address - Street 1:490 N MAIN ST # 184
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7018
Mailing Address - Country:US
Mailing Address - Phone:907-373-5801
Mailing Address - Fax:907-373-5801
Practice Address - Street 1:1160 N STANLEY ROAD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7018
Practice Address - Country:US
Practice Address - Phone:907-373-5801
Practice Address - Fax:907-373-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK901834261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL1661Medicaid