Jewel Lake Assisted Living Home LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

101014 Issued in AK

Legal business name

JEWEL LAKE ASSISTED LIVING HOME LLC

Practice address

4132 W 88TH Ave
Anchorage, AK 99502-5107

Phone

(907) 243-9570

Fax

(907) 245-0035

NPI assigned

Nov 15, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Arthur Reyes Bonglo, REGISTERED NURSE

Title

Administrator

Phone

(907) 243-9570

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1384473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384473600000",
    "number": "1255761987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4132 WEST 88TH AVE.",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "99502",
            "telephone_number": "907-243-9570",
            "fax_number": "907-245-0035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4132 W 88TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995025107",
            "telephone_number": "907-243-9570",
            "fax_number": "907-245-0035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEWEL LAKE ASSISTED LIVING HOME LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-15",
        "last_updated": "2013-11-15",
        "status": "A",
        "authorized_official_last_name": "BONGLO",
        "authorized_official_first_name": "ARTHUR",
        "authorized_official_middle_name": "REYES",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-243-9570",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "REGISTERED NURSE"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "101014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; 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.