Professional Home IV Inc

Primary specialty

Home Infusion Therapy PharmacyTaxonomy code 3336H0001X

License

490 Issued in AK

Legal business name

PROFESSIONAL HOME IV INC

Practice address

182 S Birch St
Soldotna, AK 99669-8020

Phone

(907) 262-8737

Fax

(907) 260-7405

NPI assigned

Jul 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

James Kevin Henderson, RPHNPI 1457625899

Title

Owner

Phone

(907) 262-8737

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in AK

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Kevin Henderson, RPH

  • Pharmacist
  • Soldotna, AK
  • NPI 1457625899
  NPD Authorized official
• Lori Ann Devito, RPH

  • Pharmacist
  • Soldotna, AK
  • NPI 1407880560
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664236800000",
    "number": "1053341966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "182 S BIRCH ST",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996698020",
            "telephone_number": "907-262-8737",
            "fax_number": "907-260-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 S BIRCH ST",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996698020",
            "telephone_number": "907-262-8737",
            "fax_number": "907-260-7405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL HOME IV INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2022-09-27",
        "certification_date": "2022-09-27",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "907-262-8737",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "AK",
            "license": "490",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "AK",
            "license": "PHAR490",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PH0246",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1021642",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "MS1723",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1028530",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1619615",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crystal M Prescott
• Makayla R Prescott
• Linda Kay Price, R.N.
• Heather Pritchard, LMT
• Robin L Probart
• Kate Pruitt
• Sandra K Puckett, D.C.
• Matthew Allan Pyhala, D.C.
• Sarah Louise Pyhala, PT, DPT
• Qavanguq Inc

• Home Infusion Therapy Pharmacy in Soldotna, AK
• Providers in Soldotna, AK by specialty
• Home Infusion Therapy Pharmacy in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.