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General NPI Number Information
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NPI Number | 1891944401
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Entity Type | Organization
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Legal Business Name | KENNETH OWENS
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 48395 LAKESIDE AVE
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City | SOLDOTNA
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State | AK
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Zip | 99669-9125
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Country | US
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Telephone | 907-398-6665
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Fax | 907-260-8085
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Provider Business Mailing Address
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Address Line | 48395 LAKESIDE AVE
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City | SOLDOTNA
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State | AK
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Zip | 99669-9125
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Country | US
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Telephone | 907-398-6665
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Fax | 907-260-8085
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Authorized Official
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Title or Position | OWNER
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Name | MISS KENNETH PAUL OWENS
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Credential | CONTRACTOR
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Telephone | 907-398-6665
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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 | 916777
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License Number State | AK
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