Provider Demographics
NPI:1720537707
Name:PRIBBENOW PLACE
Entity Type:Organization
Organization Name:PRIBBENOW PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIBBENOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-252-5048
Mailing Address - Street 1:PO BOX 1321
Mailing Address - Street 2:
Mailing Address - City:KENAI
Mailing Address - State:AK
Mailing Address - Zip Code:99611-1321
Mailing Address - Country:US
Mailing Address - Phone:907-252-5048
Mailing Address - Fax:
Practice Address - Street 1:1115 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:KENAI
Practice Address - State:AK
Practice Address - Zip Code:99611-7506
Practice Address - Country:US
Practice Address - Phone:907-252-5048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-01
Last Update Date:2016-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care