| NPI | 1003101825 |
|---|---|
| Doing Business As | FANCY MOOSE ASSISTED LIVING |
| Entity Type | Organization |
| Authorized Contact | LISA STEVENS Administrator Designee 907-230-5205 |
| Organization Subpart ? | No |
| Primary Taxonomy | 310400000X Assisted Living Facility (Licence: AK 100908) |
| Enumeration Date | 2011-06-09 |
| Last Update Date | 2011-06-09 |