Provider Demographics
NPI:1346250982
Name:CITY OF HOMER
Entity Type:Organization
Organization Name:CITY OF HOMER
Other - Org Name:HOMER VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-235-8121
Mailing Address - Street 1:491 E PIONEER AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7624
Mailing Address - Country:US
Mailing Address - Phone:907-235-8121
Mailing Address - Fax:907-435-0402
Practice Address - Street 1:491 E PIONEER AVE
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7624
Practice Address - Country:US
Practice Address - Phone:907-235-8121
Practice Address - Fax:907-235-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK02603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKTR0115Medicaid
AKK0000RGBPLMedicare ID - Type UnspecifiedMEDICARE PROVIDER #