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2650 E Broadview Ave Wasilla AK 99654-8302 | |
| (907) 313-1333 | |
| (907) 357-8781 |
| Full Name | |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 2650 E Broadview Ave, Wasilla, Alaska |
| Authorized Official Name and Position | Karl R Soderstrom (CEO) |
| Authorized Official Contact | 9073131333 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
357 E Parks Hwy Ste 100 Wasilla AK 99654-7005 Ph: (907) 313-1333 | 2650 E Broadview Ave Wasilla AK 99654-8302 Ph: (907) 313-1333 |
| NPI Number | 1942829460 |
|---|---|
| Provider Enumeration Date | 04/14/2020 |
| Last Update Date | 05/11/2023 |
| Certification Date | 05/11/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942829460 | NPI | - | NPPES |
| 1727147 | Medicaid | AK |
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