Provider Demographics
NPI:1609181197
Name:OUR HOME ASSISTED LIVING HOME,LLC
Entity Type:Organization
Organization Name:OUR HOME ASSISTED LIVING HOME,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARICHELLE
Authorized Official - Middle Name:RODRIGUEZ
Authorized Official - Last Name:PAGTAKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-317-6005
Mailing Address - Street 1:9330 APHRODITE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1493
Mailing Address - Country:US
Mailing Address - Phone:907-317-6005
Mailing Address - Fax:
Practice Address - Street 1:9330 APHRODITE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1493
Practice Address - Country:US
Practice Address - Phone:907-317-6005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK942880310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility