| NPI | 1053852061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL ANDERSON WHITNEY Administrator 907-745-4423 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AK 101216) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2017-03-10 |