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General NPI Number Information
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NPI Number | 1386264026
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Entity Type | Organization
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Legal Business Name | KODIAK CORPORATION
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Dates
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Enumeration Date | 04/23/2020
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 451 OAK ST STE 207
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City | FREDERICK
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State | CO
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Zip | 80530-7015
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Country | US
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Telephone | 720-738-0044
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Fax | 720-738-0045
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Provider Business Mailing Address
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Address Line | PO BOX 932
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City | FREDERICK
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State | CO
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Zip | 80530-0932
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Country | US
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Telephone | 303-915-9848
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Fax | 720-738-0045
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | CHARLES W. NEW JR.
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Credential |
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Telephone | 303-915-9848
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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