Organization
BORETIDE BEHAVIORAL HEALTH, LLC
Active
Organization
BORETIDE BEHAVIORAL HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY MOORE PMHNP-BC (OWNER AND EMPLOYED PROVIDER)
(907) 931-8618
Entity
Organization
Contact information
Practice address
3300 ARCTIC BLVD STE 201, ANCHORAGE, AK 99503-4579
(907) 931-8618
Mailing address
3300 ARCTIC BLVD SUITE 201 PMB 1279, ANCHORAGE, AK 99503-4733
(907) 931-8618
(907) 931-6387
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
11/17/2022
Last updated
02/02/2023
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