Provider Demographics
NPI:1376368829
Name:EMK INNOVATIVE HEALTH CARE CLINIC
Entity type:Organization
Organization Name:EMK INNOVATIVE HEALTH CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRIETTA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMOKIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN
Authorized Official - Phone:907-317-1703
Mailing Address - Street 1:PO BOX 140665
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99514-0665
Mailing Address - Country:US
Mailing Address - Phone:907-317-1703
Mailing Address - Fax:
Practice Address - Street 1:204 MULDOON RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-1502
Practice Address - Country:US
Practice Address - Phone:907-317-1703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMK INNOVATIVE HEALTH CARE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health