Healthcare Provider Details

I. General information

NPI: 1003941675
Provider Name (Legal Business Name): KWAJALEIN RANGE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

OCEAN ROAD BOX 1702
APO AP
96555
UM

IV. Provider business mailing address

PO BOX 1321 OCEAN ROAD
APO AP
96555
US

V. Phone/Fax

Practice location:
  • Phone: 805-355-2220
  • Fax: 805-355-1885
Mailing address:
  • Phone: 805-355-2220
  • Fax: 805-355-1885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberNONE -NOT IN U.S.
License Number State

VIII. Authorized Official

Name: MS. LINN EZELL
Title or Position: SUPERVISOR, BUSINESS OPERATIONS
Credential:
Phone: 805-355-2220