Provider Demographics
NPI:1982827663
Name:ST MARYS ASSISTED LIVING HOME
Entity Type:Organization
Organization Name:ST MARYS ASSISTED LIVING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:PARONE
Authorized Official - Last Name:GAUTHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-349-0446
Mailing Address - Street 1:441 BONNIE JEAN CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3346
Mailing Address - Country:US
Mailing Address - Phone:907-349-0446
Mailing Address - Fax:907-677-6317
Practice Address - Street 1:441 BONNIE JEAN CT
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3346
Practice Address - Country:US
Practice Address - Phone:907-349-0446
Practice Address - Fax:907-677-6317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100284310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility