| NPI | 1922436732 |
|---|---|
| Former Legal Business Name | OWNER |
| Entity Type | Organization |
| Authorized Contact | JOYCE MEWBORN Owner 907-602-0818 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM0850X Clinic/Center, Adult Mental Health |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2013-10-15 |