| NPI | 1255867263 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA MCCLUSKEY Administrator 907-354-3441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AK 100437) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2017-05-11 |