Our Lady of Grace Home

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

740505 Issued in AK

Legal business name

OUR LADY OF GRACE HOME

Practice address

3730 W 74TH Ave
Anchorage, AK 99502-2862

Phone

(907) 868-8863

Fax

(907) 868-8863

NPI assigned

May 11, 2007

Last updated

Mar 3, 2008By 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

Rodelia Tamilag Pacudan

Title

Administrator

Phone

(907) 868-8863

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1922213925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3730 W 74TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995022862",
            "telephone_number": "907-868-8863",
            "fax_number": "907-868-8863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3730 W 74TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995022862",
            "telephone_number": "907-868-8863",
            "fax_number": "907-868-8863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUR LADY OF GRACE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "PACUDAN",
        "authorized_official_first_name": "RODELIA",
        "authorized_official_middle_name": "TAMILAG",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-868-8863"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "AK",
            "license": "740505",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RL3014",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Ouellette, DPT
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• Our Lady of Guadalupe LLC
• Our Lady of Guadalupe, L. L. C.
• Our Lady of Guadalupe, L.L.C
• Our Lady of Guadalupe, L.L.C.
• Our Lady of Lourdes, LLC

• Assisted Living Facility in Anchorage, AK
• Providers in Anchorage, 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 Mar 3, 2008; 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.