Healthcare Provider Details

I. General information

NPI: 1407907629
Provider Name (Legal Business Name): PALMER SENIOR CITIZENS CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 S CHUGACH ST
PALMER AK
99645-6627
US

IV. Provider business mailing address

1132 S CHUGACH ST
PALMER AK
99645-6627
US

V. Phone/Fax

Practice location:
  • Phone: 907-623-7723
  • Fax: 907-746-5173
Mailing address:
  • Phone: 907-623-7723
  • Fax: 907-746-5173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number261860
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number261859
License Number StateAK
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number261859
License Number StateAK
# 4
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number283892
License Number StateAK
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number261861
License Number StateAK

VIII. Authorized Official

Name: TIMOTHY PETTIT
Title or Position: CEO
Credential:
Phone: 907-761-5008