Provider Demographics
NPI:1710185780
Name:OUR LADY OF GUADALUPE, L. L. C.
Entity Type:Organization
Organization Name:OUR LADY OF GUADALUPE, L. L. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANALIZA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:PENTECOSTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-338-9588
Mailing Address - Street 1:8211 MAJESTIC DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4702
Mailing Address - Country:US
Mailing Address - Phone:907-338-9588
Mailing Address - Fax:907-644-7944
Practice Address - Street 1:8211 MAJESTIC DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4702
Practice Address - Country:US
Practice Address - Phone:907-338-9588
Practice Address - Fax:907-644-7944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100600310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility