Healthcare Provider Details

I. General information

NPI: 1437272168
Provider Name (Legal Business Name): STONE BROOK INN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 WARE HOUSE DR
SOLDOTNA AK
99669-7930
US

IV. Provider business mailing address

PO BOX 144
SOLDOTNA AK
99669-0144
US

V. Phone/Fax

Practice location:
  • Phone: 907-260-3807
  • Fax: 907-262-1593
Mailing address:
  • Phone: 907-260-3807
  • Fax: 907-262-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AUDRA HEDMAN
Title or Position: PRESIDENT-ADMINISTRATOR
Credential:
Phone: 907-252-2679