| NPI | 1548744469 |
|---|---|
| Other Name | INDEPENDENCE LODGE, LLC |
| Entity Type | Organization |
| Authorized Contact | DEVON URQUHART Administrator 907-351-5931 |
| Organization Subpart ? | No |
| Primary Taxonomy | 385H00000X Respite Care |
| Enumeration Date | 2018-09-17 |
| Last Update Date | 2018-09-17 |