Organization
SANCTUARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MILDRED Q. LUJAN (EXECUTIVE DIRECTOR)
(671) 475-7101
Entity
Organization
Contact information
Practice address
406 MAIMAI ST, CHALAN PAGO, GU 96910-5669
(671) 475-7101
Mailing address
406 MAIMAI ST, CHALAN PAGO, GU 96910-5669
(671) 475-7101
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
2696
GU
251S00000X
Community/Behavioral Health Agency
2696
GU
252Y00000X
Early Intervention Provider Agency
2696
GU
305S00000X
Point of Service
2696
GU
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
2696
GU
324500000X
Substance Abuse Rehabilitation Facility
2696
GU
Other
Enumeration date
10/24/2012
Last updated
10/24/2012
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