Main Street Assisted Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

00242 Issued in AK

Legal business name

MAIN STREET ASSISTED LIVING, INC.

Practice address

4136 Main St
Homer, AK 99603-7035

Phone

(907) 235-6149

Fax

(907) 235-6149

NPI assigned

Mar 21, 2007

Last updated

Apr 13, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ruth E Babcock

Title

Administrator

Phone

(907) 235-6149

Specialties & licenses 3

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1271116800000",
    "number": "1023134178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4136 MAIN ST",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037035",
            "telephone_number": "907-235-6149",
            "fax_number": "907-235-6149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4136 MAIN ST",
            "city": "HOMER",
            "state": "AK",
            "postal_code": "996037035",
            "telephone_number": "907-235-6149",
            "fax_number": "907-235-6149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET ASSISTED LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-21",
        "last_updated": "2010-04-13",
        "status": "A",
        "authorized_official_last_name": "BABCOCK",
        "authorized_official_first_name": "RUTH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-235-6149"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "00242",
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "AK",
            "license": "00242",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "AK",
            "license": "00242",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RL8609",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Melissa Elizabeth Malcolm, PTA
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• Assisted Living Facility in Homer, AK
• Providers in Homer, AK by specialty
• Assisted Living Facility in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.