Provider Demographics
NPI:1811311939
Name:HERITAGE HEALTH AND BIRTH SOLDOTNA LLC
Entity type:Organization
Organization Name:HERITAGE HEALTH AND BIRTH SOLDOTNA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:KILIC
Authorized Official - Suffix:
Authorized Official - Credentials:CDM
Authorized Official - Phone:907-382-0625
Mailing Address - Street 1:7200 E VALLEY CIR SUITE 6
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-5936
Mailing Address - Country:US
Mailing Address - Phone:907-746-6644
Mailing Address - Fax:
Practice Address - Street 1:2323 S TRUNK RD SUITE 6
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-5936
Practice Address - Country:US
Practice Address - Phone:907-746-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKFBC-009261QB0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthingGroup - Single Specialty