Provider Demographics
NPI:1437553716
Name:OMA & OPA'S PLACE ALH, LLC
Entity type:Organization
Organization Name:OMA & OPA'S PLACE ALH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOHLERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-868-3620
Mailing Address - Street 1:1550 E TIERRA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-3529
Mailing Address - Country:US
Mailing Address - Phone:907-631-3537
Mailing Address - Fax:
Practice Address - Street 1:1550 E TIERRA GRANDE DR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-3529
Practice Address - Country:US
Practice Address - Phone:907-631-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101064310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility