Healthcare Provider Details

I. General information

NPI: 1932824539
Provider Name (Legal Business Name): HARVEST HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 E TUDOR RD STE 9A
ANCHORAGE AK
99507-1036
US

IV. Provider business mailing address

1515 E TUDOR RD STE 9A
ANCHORAGE AK
99507-1036
US

V. Phone/Fax

Practice location:
  • Phone: 832-409-9104
  • Fax: 907-308-3820
Mailing address:
  • Phone: 832-409-9104
  • Fax: 907-308-3820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY LIPINSKI
Title or Position: OWNER
Credential:
Phone: 832-409-9104