Provider Demographics
NPI:1255635181
Name:NORTHERN HOME HEALTH, LLC
Entity type:Organization
Organization Name:NORTHERN HOME HEALTH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:907-868-1919
Mailing Address - Street 1:PO BOX 220813
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99522-0813
Mailing Address - Country:US
Mailing Address - Phone:907-868-1919
Mailing Address - Fax:907-245-6269
Practice Address - Street 1:4101 ARCTIC BLVD
Practice Address - Street 2:STE. 105
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-5702
Practice Address - Country:US
Practice Address - Phone:907-868-1919
Practice Address - Fax:907-245-6269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care