Provider Demographics
NPI:1710336086
Name:HOMER SENIOR CITIZENS, INC.
Entity Type:Organization
Organization Name:HOMER SENIOR CITIZENS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:907-235-4551
Mailing Address - Street 1:3935 SVEDLUND ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:AK
Mailing Address - Zip Code:99603-7673
Mailing Address - Country:US
Mailing Address - Phone:907-235-4551
Mailing Address - Fax:907-235-3739
Practice Address - Street 1:3935 SVEDLUND ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:AK
Practice Address - Zip Code:99603-7673
Practice Address - Country:US
Practice Address - Phone:907-235-4551
Practice Address - Fax:907-235-3739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility