| NPI | 1144784760 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARL ROBERT SODERSTROM CEO 907-313-1333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-01-28 |
| Last Update Date | 2024-03-05 |