Organization
ALASKAN SOURDOUGH ENTERPRISES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VINCENT MALONE JOHNSON (OWNER)
(907) 335-0559
Entity
Organization
Contact information
Practice address
225 PHILLIPS DR, KENAI, AK 99611-8447
(907) 335-0559
Mailing address
225 PHILLIPS DR., KENAI, AK 99611-8447
(907) 335-0559
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
925679
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2580
—
AK
Enumeration date
04/01/2010
Last updated
04/01/2010
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