| NPI | 1255881637 |
|---|---|
| Doing Business As | TRIBAL- DETOX |
| Doing Business As | BSD- DETOX |
| Entity Type | Organization |
| Authorized Contact | RONALD LEE OLSON Executive Vice President Finance 907-729-4949 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2023-08-31 |