Healthcare Provider Details

I. General information

NPI: 1558631846
Provider Name (Legal Business Name): THE ARK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 SEABREEZE CT
HOMER AK
99603-7935
US

IV. Provider business mailing address

1136 SEABREEZE CT
HOMER AK
99603-7935
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-7942
  • Fax: 907-235-8851
Mailing address:
  • Phone: 907-235-7942
  • Fax: 907-235-8851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number967467
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number967467
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number967467
License Number StateAK

VIII. Authorized Official

Name: LAURA L OWENS
Title or Position: OWNER
Credential: RN
Phone: 907-235-7942