Provider Demographics
NPI:1275672370
Name:SENIOR CITIZENS OF KODIAK, INC.
Entity Type:Organization
Organization Name:SENIOR CITIZENS OF KODIAK, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-486-6181
Mailing Address - Street 1:302 ERSKINE AVE
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6341
Mailing Address - Country:US
Mailing Address - Phone:907-486-6181
Mailing Address - Fax:907-486-4503
Practice Address - Street 1:302 ERSKINE AVE
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6341
Practice Address - Country:US
Practice Address - Phone:907-486-6181
Practice Address - Fax:907-486-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCMG249311500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK=========OtherSENIOR CENTER