| NPI | 1144985961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LONNIE RIDGEWAY Owner/Administrator 907-310-5310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2021-11-05 |
| Last Update Date | 2021-11-05 |