Provider Demographics
NPI:1407907629
Name:PALMER SENIOR CITIZENS CENTER, INC.
Entity type:Organization
Organization Name:PALMER SENIOR CITIZENS CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-761-5008
Mailing Address - Street 1:1132 S CHUGACH ST
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6627
Mailing Address - Country:US
Mailing Address - Phone:907-623-7723
Mailing Address - Fax:907-746-5173
Practice Address - Street 1:1132 S CHUGACH ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6627
Practice Address - Country:US
Practice Address - Phone:907-623-7723
Practice Address - Fax:907-746-5173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK261860251B00000X
AK261859251V00000X, 261Q00000X
AK283892261QA0600X
AK261861343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No251B00000XAgenciesCase Management
No251V00000XAgenciesVoluntary or Charitable
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC7853Medicaid
AKCMG503Medicaid
AKTX6161Medicaid