| NPI | 1992378517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD BRUCE JOHNSON Owner/Director 907-227-3524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2025-10-15 |