Organization
PROFESSIONAL CARE SERVICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JESSICA URENA I 051368 (OWNED)
(907) 346-4410
Entity
Organization
Contact information
Practice address
1743 MINERVA WAY, SAME, ANCHORAGE, AK 99515-1490
(907) 346-4410
(907) 346-4410
Mailing address
1743 MINERVA WAY, SAME, ANCHORAGE, AK 99515-1490
(907) 346-4410
(907) 346-4412
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
928682
AK
Other
Enumeration date
03/11/2010
Last updated
03/11/2010
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