| NPI | 1154580835 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JESS G ADAMS Staff Office 907-892-6944 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AK 100554) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2009-07-22 |