# FANCY MOOSE ANCHORAGE ALH

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265854186
- **Authorized official:** MATTHEW ALAN DOBBS (ADMINISTRATOR)
- **Authorized official phone:** (907) 699-8581

## Contact information

- **Practice address:** 705 W 47TH AVE, ANCHORAGE, AK 99503-7111
- **Practice address phone:** (907) 699-8581
- **Mailing address:** 705 W 47TH AVE, ANCHORAGE, AK 99503-7111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 101034 | AK | Yes |

## Other

- **Enumeration date:** 01/12/2014
- **Last updated:** 01/12/2014