| NPI | 1306909197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACK DUCKWORTH Director 907-225-4664 |
| Organization Subpart ? | No |
| Primary Taxonomy | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| Additional Taxonomies | 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2009-04-23 |