Provider Demographics
NPI:1760755045
Name:SOLDOTNA AREA SENIOR CITIZENS INC
Entity Type:Organization
Organization Name:SOLDOTNA AREA SENIOR CITIZENS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:FENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-262-2322
Mailing Address - Street 1:197 W PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7551
Mailing Address - Country:US
Mailing Address - Phone:907-262-2322
Mailing Address - Fax:907-262-2147
Practice Address - Street 1:197 W PARK AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7551
Practice Address - Country:US
Practice Address - Phone:907-262-2322
Practice Address - Fax:907-262-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKHC6416332U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332U00000XSuppliersHome Delivered Meals
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC6416Medicaid