Provider Demographics
NPI:1396325890
Name:MCKENZIE ASSISTED LIVING 2
Entity type:Organization
Organization Name:MCKENZIE ASSISTED LIVING 2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-748-5547
Mailing Address - Street 1:3913 LYNN DR APT C
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5745
Mailing Address - Country:US
Mailing Address - Phone:907-748-5547
Mailing Address - Fax:
Practice Address - Street 1:3913 LYNN DR APT C
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5745
Practice Address - Country:US
Practice Address - Phone:907-748-5547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCKENZIE ASSISTED LIVING 1
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health