Organization
BRANCHING OUT SUPPORTED SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN WRIGHTSMAN (EXECUTIVE DIRECTOR)
(907) 987-9267
Entity
Organization
Contact information
Practice address
8132 E 32ND AVE UNIT A, ANCHORAGE, AK 99504-4112
(907) 987-9267
Mailing address
1584 HILTON AVE, FAIRBANKS, AK 99701-4016
(907) 987-9267
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942785464
—
AK
Enumeration date
08/09/2019
Last updated
11/22/2022
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