| NPI | 1265781306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTTY NORMAN JACKSON Owner/Administrator 907-830-4247 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AK 978510) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: AK 100979) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2012-09-05 |