| NPI | 1710132345 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERTA ELLEN SANDOVAL Administrator 907-495-2999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: AK 100142) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2008-11-24 |