Healthcare Provider Details

I. General information

NPI: 1922036060
Provider Name (Legal Business Name): CENTRAL PENINSULA GENERAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 ROCKWELL
SOLDOTNA AK
99669
US

IV. Provider business mailing address

232 ROCKWELL
SOLDOTNA AK
99669
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-2545
  • Fax: 907-260-4590
Mailing address:
  • Phone: 907-262-2545
  • Fax: 907-260-4590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number736259
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number736259
License Number StateAK

VIII. Authorized Official

Name: RICHARD DAVIS
Title or Position: CEO
Credential:
Phone: 907-714-4723