Organization
BRENDAN MCCANN
Active
Other names
Home on Mulchatna
Organization subpart
No
Provider details
NPI number
Authorized official
BRENDAN MCCANN (OWNER / OPERATOR)
(907) 841-2448
Entity
Organization
Contact information
Practice address
1460 E MULCHATNA DR, WASILLA, AK 99654-3540
(907) 841-2448
Mailing address
1460 E MULCHATNA DR, WASILLA, AK 99654-3540
(907) 841-2448
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
100393
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
AK
Enumeration date
07/23/2018
Last updated
07/23/2018
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