Healthcare Provider Details

I. General information

NPI: 1205917234
Provider Name (Legal Business Name): STONE BOOK INN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42340 DONNA CIRCLE
SOLDOTNA AK
99669
US

IV. Provider business mailing address

PO BOX 144
SOLDOTNA AK
99669
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-1583
  • Fax: 907-262-1593
Mailing address:
  • Phone: 907-262-1583
  • Fax: 907-260-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number000243
License Number StateAK

VIII. Authorized Official

Name: MRS. AUDRA MICHELIN HEDMAN
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 907-262-1583