=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316828692
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARCTIC ANGELS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2025
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36275 KENAI SPUR HWY
-----------------------------------------------------
City | SOLDOTNA
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99669-7157
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-971-0869
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 165 STANDARD DR
-----------------------------------------------------
City | KENAI
-----------------------------------------------------
State | AK
-----------------------------------------------------
Zip | 99611-8451
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 907-971-0869
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/OPERATOR
-----------------------------------------------------
Name | JACQUELYNN M HONEYSETT
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 907-971-0869
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------