Provider Demographics
NPI:1073714093
Name:PRIORITY HOME HEALTHCARE
Entity Type:Organization
Organization Name:PRIORITY HOME HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-364-3584
Mailing Address - Street 1:PO BOX 210805
Mailing Address - Street 2:
Mailing Address - City:AUKE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99821-0805
Mailing Address - Country:US
Mailing Address - Phone:907-364-3584
Mailing Address - Fax:240-218-0874
Practice Address - Street 1:3100 CHANNEL DR
Practice Address - Street 2:SUITE 314
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7814
Practice Address - Country:US
Practice Address - Phone:907-364-3584
Practice Address - Fax:240-218-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCG 245251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPCG 245Medicaid