Organization
COLONY MANOR HC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATHAN DAHL (ADMINISTRATOR)
(907) 373-1880
Entity
Organization
Contact information
Practice address
6801 WESWOOD DR, PALMER, AK 99645
(907) 373-1880
(907) 373-1820
Mailing address
PO BOX 870469, WASILLA, AK 99687
(907) 373-1880
(907) 373-1820
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
000196
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HC9797
—
AK
Enumeration date
04/21/2010
Last updated
04/21/2010
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