Provider Demographics
NPI:1265576482
Name:MARLOW MANOR ASSISTED LIVING
Entity type:Organization
Organization Name:MARLOW MANOR ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:O'TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:AGENT
Authorized Official - Phone:503-231-4922
Mailing Address - Street 1:2030 MULDOON RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3611
Mailing Address - Country:US
Mailing Address - Phone:907-338-8708
Mailing Address - Fax:907-338-8627
Practice Address - Street 1:2030 MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-3611
Practice Address - Country:US
Practice Address - Phone:907-338-8708
Practice Address - Fax:907-338-8627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK000139310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL7256Medicaid