Organization
FANCY MOOSE ANCHORAGE ALH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW ALAN DOBBS (ADMINISTRATOR)
(907) 699-8581
Entity
Organization
Contact information
Practice address
705 W 47TH AVE, ANCHORAGE, AK 99503-7111
(907) 699-8581
Mailing address
705 W 47TH AVE, ANCHORAGE, AK 99503-7111
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
101034
AK
Other
Enumeration date
01/12/2014
Last updated
01/12/2014
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