WASILLA GROUP HOME LLC (NPI# 1699320127) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699320127 |
| Entity Type | Organization |
| Organization Name | WASILLA GROUP HOME LLC |
| Practice Address |
3660 W Lynn Dr Wasilla AK 99654-0949 |
| Practice Telephone | 9073570102 |
| Practice Fax Number | 9076314253 |
| Mailing Telephone | 9073570102 |
| Mailing Fax Number | 9076314253 |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2019-08-01 |
| Authorized Official Name | MS. RENNE CHAMPAGNE (OWNER ADMINISTRATOR) |
| Authorized Official Telephone | 9073570102 |
| Authorized Official Credential | CNA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1026476 | 05 |
| Street Address |
3660 W LYNN DR |
| City | WASILLA |
| State | AK |
| Zip Code | 99654-0949 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003426784 | Colleen Maggie Newcity | Case Manager/Care Coordinator | 851 Westpoint Suite 310, Wasilla, AK 99654 | 2020-08-06 |
| 1659995884 | Amy M Lowe | Peer Specialist | 1363 W Spuce Ave, Wasilla, AK 99654 | 2020-06-03 |
| 1922648690 | Achieve Medical Alaska LLC | Clinic/Center | 1981 E Palmer, Suite 230, Wasilla, AK 99654 | 2020-01-10 |
| 1588205538 | Juan Carlos Garcia | Physician Assistant | 950 East Bogard Road, Suite 103, Wasilla, AK 99654 | 2019-10-01 |
| 1427610864 | Sharon Webb | Counselor | 705 S Knik Goose Bay Rd Suite K, Wasilla, AK 99654 | 2019-07-06 |
| 1306401864 | Logan Lee Cook | Peer Specialist | 2953 E Fairview Loop, Wasilla, AK 99654 | 2019-05-09 |
| 1053883595 | Moose Creek Medical Clinic LLC | Nurse Practitioner | 2341 S. Fern St., Suite 300, Wasilla, AK 99654 | 2018-12-21 |
| 1487124962 | Melissa A Stevens | Massage Therapist | 2201 W That Rd, Wasilla, AK 99654 | 2018-11-28 |
| 1609359561 | Audrey E Beers | Midwife | 2405 S. Knik Goose Bay Rd., Wasilla, AK 99654 | 2018-09-07 |
| 1093297418 | Karlee Janine Mccorry | Occupational Therapist | 613 S Knik-goose Bay Rd, Wasilla, AK 99654 | 2018-09-01 |
| Find all providers in zip 99654 | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861966269 | Tina Renee Hopkins | Assisted Living Facility | 3471 W Wren St, Wasilla, AK 99623 | 2019-01-18 |
| 1861995946 | A Fine Place | Assisted Living Facility | 1414 N Pioneer Peak Dr, Wasilla, AK 99654-5924 | 2018-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376169300 | Second Chance Support Services LLC | Assisted Living Facility | 741 Irwin St, Anchorage, AK 99508-1252 | 2020-06-25 |
| 1841815321 | Crisalyn Buenarte Ruiz | Assisted Living Facility | 3541 Corona Cir, Anchorage, AK 99517-1486 | 2020-06-10 |
| 1942858782 | My Home LLC | Assisted Living Facility | 6865 Viburnum Dr, Anchorage, AK 99507-2467 | 2019-08-26 |
| 1750935433 | Mind and Soul Assisted Living, LLC | Assisted Living Facility | 6124 E 12th Ave # D2, Anchorage, AK 99504-2355 | 2019-07-30 |
| 1689131989 | Tara Walker | Assisted Living Facility | 7774 Cherrywood Cir, Anchorage, AK 99507-2973 | 2019-02-23 |
| 1902381940 | Alkamba Marenah Enterprises, LLC | Assisted Living Facility | 1545 Demeure Pl, Anchorage, AK 99508-3164 | 2018-09-25 |
| 1629585229 | Jessica Tiara Fulton | Assisted Living Facility | 1001 Cherry St Unit A, Anchorage, AK 99504-2230 | 2018-01-04 |
| 1881109767 | Michael Anthony Brown | Assisted Living Facility | 7940 Little Dipper Ave, Anchorage, AK 99504-4125 | 2017-12-13 |
| 1740706548 | Susan Taylor-mclaughlin | Assisted Living Facility | 9113 Jewel Terrace St, Anchorage, AK 99502-5149 | 2017-08-15 |
| 1609309954 | Rowena R Jones | Assisted Living Facility | 4009 Scenic View, Anchorage, AK 99504 | 2017-04-04 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.