PROVIDENCE KODIAK MEDICAL CENTER (NPI# 1306147434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1306147434 |
Entity Type | Organization |
Organization Name | PROVIDENCE KODIAK MEDICAL CENTER |
Practice Address |
1915 E Rezanof Dr Kodiak AK 99615-6602 |
Practice Telephone | 9074863281 |
Practice Fax Number | 9074812497 |
Mailing Telephone | 9074863281 |
Mailing Fax Number | 9074812497 |
Enumeration Date | 2010-11-05 |
Last Update Date | 2010-11-05 |
Authorized Official Name | MS. ESTHER L HOXER (RN MANAGER) |
Authorized Official Telephone | 9074812490 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
31478 | AK | Nursing & Custodial Care Facilities |
Street Address |
1915 E REZANOF DR |
City | KODIAK |
State | AK |
Zip Code | 99615-6602 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1013905660 | Providence Health & Services Washington | General Acute Care Hospital | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2005-10-07 |
1093228348 | Stephanie Louise Hurley | Pharmacist | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2017-11-08 |
1083125355 | Kodiak Life Diagnostic Imaging, Inc | Clinic/Center | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2017-10-13 |
1639555840 | Aurora Crye | Pharmacist | 1915 E Rezanof Dr, Kodiak, AK 99615 | 2015-08-11 |
1144666918 | John Arthur Mcentee | Pharmacist | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2013-05-20 |
1508150384 | Diana Bash | Registered Nurse | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2011-06-08 |
1235421132 | Monique Patricia Reckner | Registered Nurse | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2011-05-10 |
1295032910 | Kodiak Board Certified Radiology, LLC | Radiology | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2011-02-15 |
1194032631 | Amy Jean Deer | Registered Nurse | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2010-09-03 |
1437463601 | Louisa Gayle Solesbee | Registered Nurse | 1915 E Rezanof Dr, Kodiak, AK 99615-6602 | 2010-07-30 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144864232 | Linda Irene Dunlap | Spec/Tech, Pathology | 1915 E. Remanof Drive, Kodiak, AK 99615 | 2019-10-31 |
1639638190 | Stephanie Brenteson | Community Health Worker | 125 Airport Way, Akhiok, AK 99615 | 2019-03-14 |
1609351022 | Desiree Alexis Wheeler | Optometrist | 3450 E Rezanof Dr, Kodiak, AK 99615 | 2018-10-02 |
1417479072 | Elaine Loomis Olsen | Case Manager/Care Coordinator | 1111 Purtov St., Kodiak, AK 99615 | 2017-07-14 |
1750828414 | Mary Jean Francisco | Case Manager/Care Coordinator | 717 East Rezanof Drive, Kodiak, AK 99615 | 2017-01-19 |
1558818112 | Carolyn Hawes | Case Manager/Care Coordinator | 717 Rezanof Dr, Kodiak, AK 99615 | 2016-09-01 |
1285083683 | Amanda Wilson | Community Health Worker | 124 Akhiok Street, Akhiok, AK 99615 | 2016-06-07 |
1447612056 | Kailee Champion | Massage Therapist | 3449 Rezanof Drive East, Kodiak, AK 99615 | 2016-03-23 |
1376891069 | Krystyna Mcrobert | Technician, Other | Cape Sarichef Road Bldg N46, Rockmore King Clinic, Kodiak, AK 99615 | 2012-08-28 |
1164778619 | Mark Anthony Johnson | Pharmacist | 3449 Rezanof Drive, Kodiak, AK 99615 | 2012-08-01 |
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Taxonomy Code | 311ZA0620X |
Grouping | Nursing & Custodial Care Facilities |
Classification | Custodial Care Facility |
Specialization | Adult Care Home |
A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
Notes: [7/1/2003: new] |
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1952883266 | Quality & Quantity Care Services LLC | Custodial Care Facility | 848 Elaine Dr, Anchorage, Ak, 99504, The Same, Anchorage, AK 99504 | 2018-09-04 |
1649524182 | Anchorage Adult Day Services | Custodial Care Facility | 360 Boniface Parkway, Suite B8, Anchorage, AK 99504 | 2012-11-06 |
1245591940 | Kiwi Assisted Living Home IIi | Custodial Care Facility | 2948 Princeton Way, Anchorage, AK 99508-4479 | 2012-05-30 |
1932482619 | Elaine's Place | Custodial Care Facility | 1025 H St, Anchorage, AK 99501-3430 | 2011-09-20 |
1144509365 | Abuelita Alh, LLC | Custodial Care Facility | 1105 San Antonio St, Anchorage, AK 99508-2764 | 2011-08-04 |
1114150513 | Gloria's Golden Heart Assisted Living, LLC | Custodial Care Facility | 3713 Robin St, Anchorage, AK 99504-4674 | 2009-09-01 |
1003090176 | Comfort Assisted Living Homes | Custodial Care Facility | 7370 Winchester St, Anchorage, AK 99507-2856 | 2007-12-24 |
1548461445 | Graceful Living LLC | Custodial Care Facility | 6300 E 9th Ave, Anchorage, AK 99504-1720 | 2007-05-29 |
1104957760 | Comfort Assisted Living Home | Custodial Care Facility | 7390 Winchester St, Anchorage, AK 99507-2856 | 2007-03-08 |
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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.