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Organization
PROVIDENCE KODIAK MEDICAL CENTER
Active
Organization
PROVIDENCE KODIAK MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD WAYNE ANDERSON JR. (ASSISTANT SECRETARY OF ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
1915 E REZANOF DR, KODIAK, AK 99615-6602
(907) 486-3281
(907) 481-2497
Mailing address
1915 E REZANOF DR, KODIAK, AK 99615-6602
(907) 486-3281
(907) 481-2497
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
31478
AK
Other
Enumeration date
11/05/2010
Last updated
05/15/2025
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