Kenai Peninsula Home Health LLC
Organization Active NPI Home Health Agency · Soldotna, AK
NPI 1821632258 · NPPES record last updated May 4, 2023
Key facts
- NPI
- 1821632258
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- KENAI PENINSULA HOME HEALTH LLC
- Practice address
- 44332 Sterling Hwy Ste 42
Soldotna, AK 99669-8065 - Phone
- (907) 260-4444
- NPI assigned
- Oct 29, 2019
- Organization subpart
- No
Authorized official
- Name
- Vanessa Shanahan, RN
- Title
- President
- Phone
- (907) 260-4444
Practitioners 2
-
David Seramur, DPT
Affiliated clinicians 37
-
Christine M Babcock, A.N.P.
-
Erik Berger, M.D.
-
Robert E Cadoff, M.D.
-
Kylie B Jones, FNP
-
Kristina Diann Lacy, DPM
-
Stuart E Marcotte, D.O.
-
Robert Byron Mitchell, D.O.
-
Stacey Pault, PA-C
-
Bryan Lee Pherson, PA-C
-
Sarah Allen Phillips, MSN, RN, APRN, FNP-C
-
Gail Michelle Pokorney, M.D.
-
Mark Victor Restad, PA-C
-
Michael L Reyes, MD
-
Megan Roosen-Runge, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Kenai Peninsula Home Health, LLC
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Proprietary
- Certified
- Jun 24, 2020
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Physical therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 02D2175833 | Kenai Peninsula Home Health LLC | Certificate of waiver | Dec 2, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AK
Home health agency certification: CCN 027038
- Legal name
- KENAI PENINSULA HOME HEALTH LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jun 24, 2020
- Last certification
- Jun 24, 2020
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Enrollment address
- 44096 Sterling Hwy
Ste E
Soldotna, AK 99669-8063
All disclosed owners & managing parties 1
| Name | Role | Since | Share |
|---|---|---|---|
| Vanessa L Shanahan |
5% Or Greater Direct Ownership Interest | Oct 16, 2019 | 100% |
| W-2 Managing Employee |
Oct 16, 2019 | ||
| Operational/Managerial Control |
Oct 16, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200113000388 | AK | Part a Provider - Home Health Agency | 5799110169 | Practice locations: Soldotna, AK |
National Provider Directory
Locations
44332 Sterling Hwy
Soldotna, AK 99669
44332 Sterling Hwy
Ste 42
Soldotna, AK 99669
Phone (907) 260-4444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
44332 Sterling Hwy Ste 42
Soldotna, AK 99669-8065
Mailing address
PO Box 530
Soldotna, AK 99669-0530
Phone (970) 227-8811
Other providers in Soldotna, AK
- Kirsten Kempf
- Kenai Peninsula Anesthesia, LLC
- Kenai Peninsula Borough
- Kenai Peninsula Borough School District
- Kenai Peninsula Health System LLC Urgent Care of Soldotna
- Kenai Peninsula Hospice LLC
- Kenai Peninsula Massage Therapy Inc.
- Kenai Peninsula Mental Health LLC
- Kenai Peninsula Urology, LLC
- Kenai River Counseling
All providers in Soldotna, AK · Home Health Agency in Alaska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 4, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.