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General NPI Number Information
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NPI Number | 1568259208
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Entity Type | Organization
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Legal Business Name | MOUNTAIN MEADOWS ASSISTED LIVING HOME
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Dates
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Enumeration Date | 04/24/2025
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Last Update Date | 04/24/2025
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Provider Practice Location Address
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Address Line | 1662 S B SHANNON STREET
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City | WASILLA
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State | AK
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Zip | 99654
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Country | US
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Telephone | 907-746-6625
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 N ACORN ST
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City | PALMER
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State | AK
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Zip | 99645-7719
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Country | US
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Telephone | 907-841-0401
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Fax |
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Authorized Official
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Title or Position | SECRETARY/TREASURER
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Name | MRS. RACHEL DIANE OLSON
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Credential |
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Telephone | 907-982-9646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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