Our House On the Lake LLC

NPI #1407293145 in Kenai, Alaska

Provider Information

NPI Number: 1407293145
Entity Type: Organization
Organization Name: Our House On the Lake LLC
Primary Specialty: Assisted Living Facility
Enumeration Date: Jun 3, 2013
Last Updated: Jun 3, 2013

Practice Location

Address: 47710 INTERLAKE DR
City: Kenai
State: Alaska
ZIP Code: 99611-9694
Phone: (907) 776-8684

Authorized Official

Name: BONITA R QUALE
Title: SOLE MEMBER
Phone: (907) 776-8684

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility	310400000X	Primary

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