Our House on the Lake LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

224 Issued in AK

Legal business name

OUR HOUSE ON THE LAKE LLC

Practice address

47710 Interlake Dr
Kenai, AK 99611-9694

Phone

(907) 776-8684

NPI assigned

Jun 3, 2013

Organization subpart

No

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

Authorized official

Name

Bonita R QualeNPI 1396878880

Title

Sole Member

Phone

(907) 776-8684

Specialties & licenses 2

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Bonita R Quale

  • Assisted Living Facility
  • Kenai, AK
  • NPI 1396878880
  NPD (past) Authorized official

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

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370217600000",
    "number": "1407293145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47710 INTERLAKE DR",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996119694",
            "telephone_number": "907-776-8684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47710 INTERLAKE DR",
            "city": "KENAI",
            "state": "AK",
            "postal_code": "996119694",
            "telephone_number": "907-776-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR HOUSE ON THE LAKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-03",
        "last_updated": "2013-06-03",
        "status": "A",
        "authorized_official_last_name": "QUALE",
        "authorized_official_first_name": "BONITA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SOLE MEMBER",
        "authorized_official_telephone_number": "907-776-8684"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "224",
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "100608",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RL4771",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RL3719",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Diane Carol Ogilvie
• Kaija T Okkonen
• Miriam Alejandra Olivo
• Darlene Charmaine Olsen-Holst
• Halie Katerina Oskolkoff
• Sarah Palmer
• Matthew Mason Parker
• McKinzie Marie Parker
• Jason Brett Parry, PA-C
• Pathways LLC

• Assisted Living Facility in Kenai, AK
• Providers in Kenai, 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 Jun 3, 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.