Provider Demographics
NPI:1477737393
Name:PKIMC HOME HEALTH
Entity Type:Organization
Organization Name:PKIMC HOME HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER HOME HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:907-481-2490
Mailing Address - Street 1:PO BOX 9034
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-9034
Mailing Address - Country:US
Mailing Address - Phone:907-481-2490
Mailing Address - Fax:907-481-2497
Practice Address - Street 1:1915 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6602
Practice Address - Country:US
Practice Address - Phone:907-481-2490
Practice Address - Fax:907-481-2497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK16608251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health