Healthcare Provider Details

I. General information

NPI: 1922170851
Provider Name (Legal Business Name): 5-D CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N LAGOON DR.
WASILLA AK
99654
US

IV. Provider business mailing address

4300 N TRUNK RD
PALMER AK
99645
US

V. Phone/Fax

Practice location:
  • Phone: 907-746-6493
  • Fax: 907-746-6499
Mailing address:
  • Phone: 907-746-6493
  • Fax: 907-746-6499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number241
License Number StateAK

VIII. Authorized Official

Name: MERRI BELLE DIAS
Title or Position: TREASURER
Credential: LPN
Phone: 907-746-6493