| NPI | 1215750401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHNNY TYSON CEO 907-301-0333 |
| Organization Subpart ? | No |
| Primary Taxonomy | 3245S0500X Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2024-11-05 |