| Organization Name: | OUR LADY OF GUADALUPE LLC |
| NPI Number: | 1407039746 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANALIZA Y PENTECOSTES (ADMINISTRATOR) |
| Mailing Address: | 8211 Majestic Dr Anchorage |
| State: | AK US |
| Postal Code: | 995044702 |
| Phone Number: | 9073389588 |
| Fax Number: | 9076447944 |
| NPI Enumeration Date: | 12/10/2007 |
| NPI Last Update Date: | 12/12/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | HC# PENDING |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |