Provider Demographics
NPI:1619244548
Name:A KODIAK WELCOME BED AND BREAKFAST
Entity Type:Organization
Organization Name:A KODIAK WELCOME BED AND BREAKFAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BED AND BREAKFAST MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-486-2908
Mailing Address - Street 1:PO BOX 1922
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-1922
Mailing Address - Country:US
Mailing Address - Phone:907-486-2908
Mailing Address - Fax:
Practice Address - Street 1:3570 SEAN CIRCLE
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615
Practice Address - Country:US
Practice Address - Phone:907-486-2908
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK295003385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care