Sourdough'S Housing LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

101103 Issued in AK

Legal business name

SOURDOUGH'S HOUSING LLC

Practice address

2030 Muldoon Rd
Anchorage, AK 99504-3638

Phone

(907) 338-8708

Fax

(907) 338-8627

NPI assigned

Jun 9, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Patrick Otoole

Title

Agent

Phone

(503) 231-4922

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Marlow Manor Assisted Living Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433808000000",
    "number": "1154701779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2030 MULDOON RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995043638",
            "telephone_number": "907-338-8708",
            "fax_number": "907-338-8627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2030 MULDOON RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995043638",
            "telephone_number": "907-338-8708",
            "fax_number": "907-338-8627"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURDOUGH'S HOUSING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-09",
        "last_updated": "2015-06-09",
        "status": "A",
        "authorized_official_last_name": "OTOOLE",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "503-231-4922"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "101103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RLX",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marlow Manor Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Assisted Living Facility in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.