Organization
STARTING POINT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDY BRENNAN (ADMINISTRATOR/COUNSELOR SUPERVISOR)
(907) 376-6116
Entity
Organization
Contact information
Practice address
230 E PAULSON AVE, 76, WASILLA, AK 99654-7001
(907) 376-6116
Mailing address
230 E PAULSON AVE, 76, WASILLA, AK 99654-7001
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
1400000818
AK
Other
Enumeration date
10/08/2014
Last updated
10/08/2014
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