| NPI | 1902169253 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY A EGGLESTON Clinical Director 907-375-3505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 322D00000X Residential Treatment Facility, Emotionally Disturbed Children |
| 324500000X Substance Abuse Rehabilitation Facility | |
| 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children | |
| 3245S0500X Substance Abuse Rehabilitation Facility Substance Abuse Treatment, Children | |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2012-06-21 |