| NPI | 1467095836 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YAEL SARAH MARTIN HICKOK Owner 907-529-1088 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2019-10-17 |