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General NPI Number Information
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NPI Number | 1366692980
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Entity Type | Organization
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Legal Business Name | PROVIDENCE SEWARD MEDICAL & CARE CENTER
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Dates
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Enumeration Date | 09/19/2008
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 417 FIRST AVENUE
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City | SEWARD
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State | AK
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Zip | 99664-0365
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Country | US
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Telephone | 907-224-5205
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Fax | 907-224-7248
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Provider Business Mailing Address
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Address Line | PO BOX 430
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City | SEWARD
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State | AK
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Zip | 99664-0430
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Country | US
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Telephone | 907-224-5205
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Fax | 907-224-7248
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Authorized Official
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Title or Position | ASSISTANT SECRETARY OF ENROLLMENTS
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Name | DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 11176
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License Number State | AK
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