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General NPI Number Information
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NPI Number | 1437553716
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Entity Type | Organization
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Legal Business Name | OMA & OPA'S PLACE ALH, LLC
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 1550 E TIERRA GRANDE DR
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City | WASILLA
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State | AK
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Zip | 99654-3529
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Country | US
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Telephone | 907-631-3537
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Fax |
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Provider Business Mailing Address
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Address Line | 1550 E TIERRA GRANDE DR
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City | WASILLA
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State | AK
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Zip | 99654-3529
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Country | US
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Telephone | 907-631-3537
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CAROLYN WOHLERS
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Credential | RN
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Telephone | 907-868-3620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 101064
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License Number State | AK
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