| Organization Name: | PROVIDENCE KODIAK MEDICAL CENTER |
| NPI Number: | 1306147434 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ESTHER L HOXER (RN MANAGER) |
| Mailing Address: | 1915 E Rezanof Dr Kodiak |
| State: | AK US |
| Postal Code: | 996156602 |
| Phone Number: | 9074863281 |
| Fax Number: | 9074812497 |
| NPI Enumeration Date: | 11/05/2010 |
| NPI Last Update Date: | 11/05/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 311ZA0620X |
| License Number: | 31478 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AK |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Custodial Care Facility |
| Taxonomy Specialization: | Adult Care Home |
| Taxonomy Definition: | A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |