Provider Demographics
NPI:1891944401
Name:KENNETH OWENS
Entity Type:Organization
Organization Name:KENNETH OWENS
Other - Org Name:BROTHERS AND SONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:CONTRACTOR
Authorized Official - Phone:907-398-6665
Mailing Address - Street 1:48395 LAKESIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-9125
Mailing Address - Country:US
Mailing Address - Phone:907-398-6665
Mailing Address - Fax:907-260-8085
Practice Address - Street 1:48395 LAKESIDE AVE
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-9125
Practice Address - Country:US
Practice Address - Phone:907-398-6665
Practice Address - Fax:907-260-8085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK916777251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health