Organization
MANIILAQ ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. IAN ERLICH (PRESIDENT/CEO)
(907) 442-3312
Entity
Organization
Contact information
Practice address
733 SECOND AVENUE, FERGUSON BUILDING, KOTZEBUE, AK 99752-0256
(907) 442-3321
Mailing address
#256 2ND AVENUE, F.R.FERGUSON BUILDING, KOTZEBUE, AK 99752-0256
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
RL3590
AK
Other
Enumeration date
12/02/2010
Last updated
12/02/2010
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