Provider Demographics
NPI:1265563324
Name:PRIORITY HEALTHCARE, LLC
Entity type:Organization
Organization Name:PRIORITY HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-364-3584
Mailing Address - Street 1:PO BOX 210805
Mailing Address - Street 2:
Mailing Address - City:AUKE BAY
Mailing Address - State:AK
Mailing Address - Zip Code:99821-0805
Mailing Address - Country:US
Mailing Address - Phone:907-364-3584
Mailing Address - Fax:
Practice Address - Street 1:3100 CHANNEL DR
Practice Address - Street 2:SUITE 314
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7814
Practice Address - Country:US
Practice Address - Phone:907-364-3584
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
AKAK719333253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management