| Organization Name: | WASILLA RETIREMENT, LLC |
| NPI Number: | 1467696641 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BONNIE JEAN KELLY (DIRECTOR OF NURSING) |
| Mailing Address: | 889 N. Elkhorn Drive Wasilla |
| State: | AK US |
| Postal Code: | 99654 |
| Phone Number: | 9073735500 |
| Fax Number: | 6057258754 |
| NPI Enumeration Date: | 05/01/2009 |
| NPI Last Update Date: | 12/15/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 385H00000X |
| License Number: | 100747 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | AK |
| Taxonomy Type: | Respite Care Facility |
| Taxonomy Classification: | Respite Care |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |