Healthcare Provider Details

I. General information

NPI: 1235353970
Provider Name (Legal Business Name): HOMER SENIOR CITIZENS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3935 SVEDLUND ST
HOMER AK
99603-7673
US

IV. Provider business mailing address

3935 SVEDLUND ST
HOMER AK
99603-7673
US

V. Phone/Fax

Practice location:
  • Phone: 907-235-7655
  • Fax: 907-235-3739
Mailing address:
  • Phone: 907-235-7655
  • Fax: 907-235-3739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number203960
License Number StateAK

VIII. Authorized Official

Name: FRED L LAU
Title or Position: ADMINISTRATOR
Credential:
Phone: 907-235-7655