Organization
OUR HOUSE ON THE LAKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BONITA R QUALE (SOLE MEMBER)
(907) 776-8684
Entity
Organization
Contact information
Practice address
47710 INTERLAKE DR, KENAI, AK 99611-9694
(907) 776-8684
Mailing address
47710 INTERLAKE DR, KENAI, AK 99611-9694
(907) 776-8684
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
100608
AK
310400000X
Assisted Living Facility
Primary
224
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RL3719
—
AK
05
—
RL4771
—
AK
Enumeration date
06/03/2013
Last updated
06/03/2013
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