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NPI Code Detail

MEDICARE: ALASKA ADDICTION REHABILITATION SERVICES INC. DBA NUGEN'S RANCH

MEDICARE: ALASKA ADDICTION REHABILITATION SERVICES INC. DBA NUGEN'S RANCH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1417503764
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALASKA ADDICTION REHABILITATION SERVICES INC. DBA NUGEN'S RANCH
Provider Business Mailing Address
First Line : PO BOX 871545
Second Line :
City : WASILLA
State : AK
Zip : 99687-1545
Country : US
Telephone Number : 907-376-4534
Fax Number : 907-376-2348
Provider Business Practice Location Address
First Line : 26731 W POINT MACKENZIE RD
Second Line :
City : WASILLA
State : AK
Zip : 99623-8709
Country : US
Telephone Number : 907-376-4534
Fax Number : 907-376-2348
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. ROBERT BODNAR
Credential : MS
Telephone Number : 907-376-4534
Provider Enumeration Date : 08/13/2019
Last Update Date : 08/13/2019

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Directions to “ALASKA ADDICTION REHABILITATION SERVICES INC. DBA NUGEN'S RANCH ” Practice Location

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