Healthcare Provider Details

I. General information

NPI: 1366658981
Provider Name (Legal Business Name): YUUYARAQ HOME HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5051 ASPEN ST.
DILLINGHAM AK
99576-0497
US

IV. Provider business mailing address

PO BOX 497
DILLINGHAM AK
99576-0497
US

V. Phone/Fax

Practice location:
  • Phone: 907-842-1718
  • Fax: 907-375-2960
Mailing address:
  • Phone: 907-842-1718
  • Fax: 907-375-2960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPCG267
License Number StateAK

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. ANTHONY OLIVER HOLMES
Title or Position: DIRECTOR
Credential: M.A.
Phone: 907-842-1718