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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