Organization
THE MARIETTA HOUSE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER J LOMEL (OWNER)
(907) 222-1164
Entity
Organization
Contact information
Practice address
3832 YOUNG ST, ANCHORAGE, AK 99508-4548
(907) 222-1164
(907) 222-1164
Mailing address
3832 YOUNG ST, ANCHORAGE, AK 99508-4548
(907) 222-1164
(907) 222-1164
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
101094
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RLX
—
AK
Enumeration date
01/12/2016
Last updated
01/12/2016
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