Organization
CHROI
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM C DODD (ADMINISTRATOR/OWNER)
(907) 315-8929
Entity
Organization
Contact information
Practice address
3435 N WOLVERINE DR, WASILLA, AK 99654-2704
(907) 315-8929
Mailing address
3435 N WOLVERINE DR, WASILLA, AK 99654-2704
(907) 315-8929
Taxonomy
Speciality
Code
Description
License number
State
253J00000X
Foster Care Agency
—
—
310400000X
Assisted Living Facility
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
Other
Enumeration date
02/21/2020
Last updated
02/21/2020
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