Organization
WOLVERINE ACADEMY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY ANN BARRETT-GODWIN (OWNER/DESIGNEE)
(907) 746-3442
Entity
Organization
Contact information
Practice address
15700 E CLARK RD, PALMER, AK 99645-8705
(907) 746-3442
(907) 746-4847
Mailing address
15700 E CLARK RD, PALMER, AK 99645-8705
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
942851
AK
Other
Enumeration date
03/17/2011
Last updated
03/17/2011
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