Organization
MAINSL ALASKA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DORETTA JEAN KOENIG (CFO)
(763) 416-9102
Entity
Organization
Contact information
Practice address
2029 CANNONEER CIR, ANCHORAGE, AK 99507-4697
(763) 494-4553
Mailing address
7000 78TH AVE N, BROOKLYN PARK, MN 55445-2744
(763) 494-4553
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/29/2013
Last updated
10/29/2013
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