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General NPI Number Information
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NPI Number | 1700103173
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Entity Type | Organization
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Legal Business Name | HARBOR VIEW MANOR
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Dates
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Enumeration Date | 04/26/2010
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Last Update Date | 04/26/2010
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Provider Practice Location Address
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Address Line | 4070 S BIRCH COVE DR
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City | WASILLA
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State | AK
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Zip | 99654-9456
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Country | US
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Telephone | 907-746-4220
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 N TRANQUILITY LN
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City | PALMER
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State | AK
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Zip | 99645-8624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MR. BRUCE KORMAN
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Credential |
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Telephone | 907-357-2019
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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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