Healthcare Provider Details

I. General information

NPI: 1023106606
Provider Name (Legal Business Name): HERITAGE PLACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 W ROCKWELL AVE
SOLDOTNA AK
99669-7411
US

IV. Provider business mailing address

232 W ROCKWELL AVE
SOLDOTNA AK
99669-7411
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 Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateAK

VIII. Authorized Official

Name: MRS. SHANDA ROCHELLE KITCHENS
Title or Position: FINANCIAL COORDINATOR
Credential:
Phone: 907-260-4574