Provider Demographics
NPI:1235804030
Name:KARIBU HOME
Entity Type:Organization
Organization Name:KARIBU HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONARDO
Authorized Official - Middle Name:ADOLPHUS
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-952-4651
Mailing Address - Street 1:PO BOX 211526
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99521-1526
Mailing Address - Country:US
Mailing Address - Phone:907-952-4651
Mailing Address - Fax:
Practice Address - Street 1:1617 CRESCENT DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5010
Practice Address - Country:US
Practice Address - Phone:907-952-4651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care