02D0674805 CLIA NUMBER - PROVIDENCE HOME HEALTH AK

Laboratory Demographics

CLIA Number: 02D0674805

Facility Name: PROVIDENCE HOME HEALTH AK

Facility Address:
4001 DALE STREET, SUITE 101
ANCHORAGE, AK
ZIP 99508
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Facility Phone Number: 907 563-0130

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1164532172

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name	Field Value
CLIA Number	02D0674805
LAB Type	Home Health Agency
Facility Name	PROVIDENCE HOME HEALTH AK
Street	4001 DALE STREET, SUITE 101
City	ANCHORAGE
State	AK
ZIP	99508
Phone	907 563-0130
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024