| NPI | 1962693812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDGAR LATTIMORE Owner/ Administrator 907-830-8365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: AK 100305) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2007-08-06 |