MEDICARE: MAMAS III ASSISTED LIVING HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	100312	AK

General Provider Information

NPI Number	:	1558483016
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAMAS III ASSISTED LIVING HOME

Provider Business Mailing Address
First Line	:	PO BOX 112676
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99511-2676
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 CURLEW CIR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99502-1654
Country	:	US
Telephone Number	:	907-301-0111
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	AMY ONEY
Credential	:
Telephone Number	:	907-301-0111

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	08/22/2020

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