Healthcare Provider Details

I. General information

NPI: 1689130189
Provider Name (Legal Business Name): MAPLE SPRINGS OF WASILLA SNF HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 E MERIDIAN PARK LOOP
WASILLA AK
99654-7474
US

IV. Provider business mailing address

3265 E MERIDIAN PARK LOOP
WASILLA AK
99654-7474
US

V. Phone/Fax

Practice location:
  • Phone: 907-841-1217
  • Fax: 907-373-1820
Mailing address:
  • Phone: 907-841-1217
  • Fax: 907-373-1820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: NATHAN CLAY DAHL
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-841-1217