Healthcare Provider Details

I. General information

NPI: 1760483556
Provider Name (Legal Business Name): CREDENA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2005
Last Update Date: 12/12/2023
Certification Date: 12/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 PROVIDENCE DR STE 101
ANCHORAGE AK
99508-4671
US

IV. Provider business mailing address

PO BOX 2704
PORTLAND OR
97208-2704
US

V. Phone/Fax

Practice location:
  • Phone: 907-212-5090
  • Fax: 907-212-5091
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0202072
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerNCPDP

VIII. Authorized Official

Name: MIKE SKAFI
Title or Position: AVP/SECRETARY
Credential:
Phone: 575-650-3396