NPIMap

Organization Active NPI

Colony Manor Creekside Assisted Living Homes

  • Assisted Living Facility
  • Wasilla, AK
National Provider Identifier
1821315599
Registry record updated Apr 21, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
000268 Issued in AK
Legal business name
COLONY MANOR CREEKSIDE ASSISTED LIVING HOMES
Practice address
1998 Creekside Dr
Wasilla, AK 99654
Phone
(907) 373-1880
Fax
(907) 373-1820
NPI assigned
Apr 21, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2010

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

Authorized official

Name
Mr. Nathan Dahl
Title
Administrator
Phone
(907) 373-1880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 000268 AK Primary

Addresses

Primary practice location

1998 Creekside Dr
Wasilla, AK 99654

Mailing address

PO Box 870469
Wasilla, AK 99687
Phone (907) 373-1880

Other identifiers 1

IdentifierTypeStateIssuer
RL97971MedicaidAK

National Provider Directory

National Provider Directory
Tax ID family
Colony Manor Assisted Living Homes4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1271808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271808000000",
    "number": "1821315599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 870469",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99687",
            "telephone_number": "907-373-1880",
            "fax_number": "907-373-1820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1998 CREEKSIDE DR",
            "city": "WASILLA",
            "state": "AK",
            "postal_code": "99654",
            "telephone_number": "907-373-1880",
            "fax_number": "907-373-1820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLONY MANOR CREEKSIDE ASSISTED LIVING HOMES",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-21",
        "last_updated": "2010-04-21",
        "status": "A",
        "authorized_official_last_name": "DAHL",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-373-1880",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "000268",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RL97971",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wasilla, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; 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.