| NPI | 1821691254 |
|---|---|
| Doing Business As | BH 1115- QUYANA CLUBHOUSE |
| Entity Type | Organization |
| Authorized Contact | RONALD LEE OLSON Executive Vice President Finance 907-729-4939 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2023-09-15 |