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General NPI Number Information
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NPI Number | 1619244548
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Entity Type | Organization
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Legal Business Name | A KODIAK WELCOME BED AND BREAKFAST
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 3570 SEAN CIRCLE
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City | KODIAK
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State | AK
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Zip | 99615
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Country | US
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Telephone | 907-486-2908
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1922
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City | KODIAK
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State | AK
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Zip | 99615-1922
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Country | US
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Telephone | 907-486-2908
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Fax |
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Authorized Official
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Title or Position | BED AND BREAKFAST MANAGER
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Name | MR. MICHAEL G ROSTAD
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Credential |
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Telephone | 907-486-2908
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number | 295003
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License Number State | AK
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