PROFESSIONAL HOME IV INC (NPI# 1053341966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053341966 |
| Entity Type | Organization |
| Organization Name | PROFESSIONAL HOME IV INC |
| Practice Address |
182 S Birch St Soldotna AK 99669-8020 |
| Practice Telephone | 9072628737 |
| Practice Fax Number | 9072607405 |
| Mailing Telephone | 9072628737 |
| Mailing Fax Number | 9072607405 |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2016-08-08 |
| Authorized Official Name | MR. JAMES K HENDERSON (PRESIDENT) |
| Authorized Official Telephone | 9072628737 |
| Authorized Official Credential | RPH |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336L0003X |
Pharmacy Specialization: Long Term Care Pharmacy |
PHAR490 | AK | Suppliers |
| Y | 3336H0001X |
Pharmacy Specialization: Home Infusion Therapy Pharmacy |
490 | AK | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1619615 | 05 | |
| AK | 1021642 | 05 | |
| AK | MS1723 | 05 | |
| AK | PH0246 | 05 | |
| AK | 1028530 | 05 |
| Street Address |
182 S BIRCH ST |
| City | SOLDOTNA |
| State | AK |
| Zip Code | 99669-8020 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457625899 | James Kevin Henderson | Pharmacist | 182 S Birch St, Soldotna, AK 99669-8020 | 2012-03-02 |
| 1407880560 | Lori Ann Devito | Pharmacist | 182 S Birch St, Soldotna, AK 99669-8020 | 2006-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881201226 | Kyle Arron Shassetz | Counselor | 43335 K-beach Rd., Soldotna, AK 99669 | 2020-09-29 |
| 1720614993 | Peninsula Instacare | Clinic/Center | 34581 Kenai Spur Hwy, Suite 1, Soldotna, AK 99669 | 2020-03-19 |
| 1871141077 | Alaine Viola Lagasse | Counselor | Kenai Vet Center, 43299 Kalifornsky Beach Road Ste 4, Soldotna, AK 99669 | 2019-08-30 |
| 1962970574 | Ryder R Storm | Behavior Technician | 338800 Community College Drive, Suite 1, Soldotna, AK 99669 | 2018-11-13 |
| 1356821540 | Tanecia Webster | Nurse Practitioner | 36570 Kenai Spur Hwy, Ste 103a, Soldotna, AK 99669 | 2018-08-16 |
| 1821519869 | Theresa Napolitano | Case Manager/Care Coordinator | 35477 Kenai Spur Hwy Suite 203, Soldotna, AK 99669 | 2017-06-29 |
| 1689048282 | Jeanne Bignell | Licensed Practical Nurse | 35020 Alaskan View Lane, Soldotna, AK 99669 | 2015-11-19 |
| 1952786105 | Ian Charles Mcmullen | Pharmacist | 44001 Sterling Highway, Soldotna, AK 99669 | 2015-07-29 |
| 1841679933 | Lana Clymer | Case Manager/Care Coordinator | 22994 Kalifornsky Beach Rd, Soldotna, AK 99669 | 2015-05-22 |
| 1861800773 | Phillip Bruce | Physical Therapy Assistant | 35105 Kenai Spury Hwy, Suite A, Soldotna, AK 99669 | 2014-07-24 |
| Find all providers in zip 99669 | ||||
| Taxonomy Code | 3336H0001X |
| Grouping | Suppliers |
| Classification | Pharmacy |
| Specialization | Home Infusion Therapy Pharmacy |
| Pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. |
| Notes: Source: National Home Infusion Association [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437763158 | Infuse Alaska LLC | Pharmacy | 6250 Tuttle Pl Ste 7, Anchorage, AK 99507-2094 | 2020-09-01 |
| 1942242722 | Coram Alternate Site Services, Inc. | Pharmacy | 501 W International Airport Rd Ste 4, Anchorage, AK 99518-1106 | 2006-06-13 |
| 1003008277 | Banner Health | Pharmacy | 1650 Cowles St, Dept 41b, Fairbanks, AK 99701-5925 | 2007-08-13 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.