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Contact Information

PROFESSIONAL HOME IV INC
182 S BIRCH ST
SOLDOTNA, AK99669-8020
 Phone: 907-262-8737
 Fax: 907-260-7405
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Home Infusion Therapy Pharmacy

3336H0001X 58 Medical Supply Company with Pharmacist
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for PROFESSIONAL HOME IV INC

NPI # 1053341966
LBN Legal business name PROFESSIONAL HOME IV INC
Authorized official JAMES HENDERSON - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/04/2006
Last updated 09/27/2022 - About 4 years ago
Identifiers
AK License # 490
AK License # PHAR490
AK Medicaid 1021642
AK Medicaid 1028530
AK Medicaid 1619615
AK Medicaid MS1723
AK Medicaid PH0246
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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