| NPI | 1275186975 |
|---|---|
| Doing Business As | SUD/BH 1115- ICM |
| Entity Type | Organization |
| Authorized Contact | RONALD LEE OLSON Executive Vice President Finance 907-729-4939 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2023-08-31 |