| NPI | 1215074018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER WATKINS Billing Manager 907-279-9627 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 324500000X Substance Abuse Rehabilitation Facility (Licence: AK 67187) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2019-08-08 |