| NPI | 1316497340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TASHIA AMSTISLAVSKI Owner 907-331-3163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AK 1043095) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2022-07-21 |