Doctor Name: | MS. BETTY JO COOLEY |
NPI Number: | 1508014077 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.P.N. |
License Number: | 100689 |
Business Practice Address: | 801 S Hermon Rd Wasilla, AK - 996547311 |
Business Phone Number: | 9076313971 |
Business Fax Number: | 9076314085 |
Mailing Address: | 801 S Hermon Rd, WASILLA |
State: | AK |
Postal Code: | 996547311 |
Phone Number: | 9076313971 |
Fax Number: | 9076314085 |
NPI Enumeration Date: | 09/08/2008 |
NPI Last Update Date: | 09/08/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320700000X |
License Number: | 100689 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Residential Treatment Facility, Physical Disabilities |
Taxonomy Specialization: | |
Taxonomy Definition: | A residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental disabilities and/or mental retardation and are not able to live independently. |