| Solomon Porch Llc | |
|
626 2nd St Ste 101 Fairbanks AK 99701-3466 | |
| (907) 350-4353 | |
| Not Available |
| Full Name | Solomon Porch Llc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 626 2nd St Ste 101, Fairbanks, Alaska |
| Authorized Official Name and Position | Lisa Root (SOLE MEMBER) |
| Authorized Official Contact | 9073504353 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Solomon Porch Llc 626 2nd St Ste 101 Fairbanks AK 99701-3466 Ph: (907) 350-4353 | Solomon Porch Llc 626 2nd St Ste 101 Fairbanks AK 99701-3466 Ph: (907) 350-4353 |
| NPI Number | 1467838847 |
|---|---|
| Provider Enumeration Date | 08/07/2015 |
| Last Update Date | 08/07/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467838847 | NPI | - | NPPES |
| 10031301 | Other | AK | ALASKA ENTITY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 101191 (Alaska) | Primary |
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