| NPI | 1679179204 |
|---|---|
| Doing Business As | DIAMOND WILLOW SOBER LIVING |
| Entity Type | Organization |
| Authorized Contact | RICHARD LANE DAVIS CEO 907-714-4723 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2020-12-09 |