Wasilla Group Home Llc

LBN: Wasilla Group Home Llc
Wasilla Group Home Llc is an health care organization with primary practice located at 3660 W Lynn Dr , Wasilla AK 99654-0949. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Assisted Living, Mental Illness, which is considered as the primary health care specialty. Wasilla Group Home Llc can be contacted via phone (907) 357-0102, or through Champagne, Renne via phone (907) 357-0102.

Contact Information

Primary practice address
3660 W Lynn Dr Wasilla AK 99654-0949
Phone: (907) 357-0102
Fax: (907) 631-4253
Website:
Map and Directions
Authorized official contact:
Name: Champagne, Renne Certified in Nursing Administration (CNA)
Phone: (907) 357-0102

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Assisted Living, Mental Illness 3104A0625X

Profile Details

NPI number 1699320127
LBN Legal business name Wasilla Group Home Llc
DBA Doing business as
Authorized official Champagne, Renne Certified in Nursing Administration (CNA)
Entity Organization
Organization subpart 1 No
Enumeration date Aug 1st, 2019
Last updated Aug 1st, 2019 - about 7 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1699320127 NPPES
Alaska MEDICAID 1026476

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