Organization
BRANCHING OUT SUPPORTED SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. GLENN WRIGHTSMAN (EXECUTIVE DIRECTOR)
(907) 987-9267
Entity
Organization
Contact information
Practice address
1584 HILTON AVE, FAIRBANKS, AK 99701-4016
(907) 987-9267
Mailing address
1584 HILTON AVE, FAIRBANKS, AK 99701-4016
(907) 987-9267
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/01/2018
Last updated
11/22/2022
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