| NPI | 1396097614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CATHY LEEANN TAYLOR Provider Enrollment Specialist 907-842-5201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2012-10-10 |
| Last Update Date | 2021-04-30 |