Organization
STANNEALH 1
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LUISA ESTRELLA BURKE (ADMINISTRATOR)
(907) 336-4010
Entity
Organization
Contact information
Practice address
9140 SHADY BAY CIR, ANCHORAGE, AK 99507-4917
(907) 336-4010
(907) 336-4010
Mailing address
9140 SHADY BAY CIR., ANCHORAGE, AK 99507
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
000166
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
HC12713
—
AK
Enumeration date
04/17/2007
Last updated
08/22/2020
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