Wasilla Group Home LLC

NPI #1699320127 in Wasilla, Alaska

Provider Information

NPI Number: 1699320127
Entity Type: Organization
Organization Name: Wasilla Group Home LLC
Primary Specialty: Assisted Living Facility - Assisted Living, Mental Illness
Enumeration Date: Aug 1, 2019
Last Updated: Aug 1, 2019

Practice Location

Address: 3660 W LYNN DR
City: Wasilla
State: Alaska
ZIP Code: 99654-0949
Phone: (907) 357-0102

Authorized Official

Name: MS. RENNE CHAMPAGNE, CNA
Title: OWNER ADMINISTRATOR
Phone: (907) 357-0102

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Assisted Living Facility - Assisted Living, Mental Illness — Assisted Living, Mental Illness	3104A0625X	Primary

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