| NPI | 1588411995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WYNN PENTECOSTES Administrator 907-231-0188 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320800000X Community Based Residential Treatment Facility, Mental Illness |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities |
| Enumeration Date | 2024-05-02 |
| Last Update Date | 2024-05-02 |