Organization
ALASKAN MANOR
Active
Organization
ALASKAN MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS BRENDA R. BONGLO (OWNER/PRESIDENT)
(907) 272-1282
Entity
Organization
Contact information
Practice address
1521 W 14TH AVE, ANCHORAGE, AK 99501-4929
(907) 272-1282
Mailing address
1521 W 14TH AVE, ANCHORAGE, AK 99501-4929
(907) 272-1282
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
100659
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100659
ASST LIVING HOME LICENSE
AK
Enumeration date
03/25/2008
Last updated
03/25/2008
Update your record
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