NPIMap

Organization Active NPI

Fancy Moose Anchorage Alh

  • Physical Disabilities Residential Treatment Facility
  • Anchorage, AK
National Provider Identifier
1265854186
Registry record updated Jan 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X
License
101034 Issued in AK
Legal business name
FANCY MOOSE ANCHORAGE ALH
Practice address
705 W 47TH Ave
Anchorage, AK 99503-7111
Phone
(907) 699-8581
NPI assigned
Jan 12, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Matthew Alan DobbsNPI 1336560838
Title
Administrator
Phone
(907) 699-8581

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Disabilities Residential Treatment Facility 320700000X 101034 AK Primary

Addresses

Primary practice location

705 W 47TH Ave
Anchorage, AK 99503-7111

Mailing address

705 W 47TH Ave
Anchorage, AK 99503-7111

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389484800000",
    "number": "1265854186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "705 W 47TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995037111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 W 47TH AVE",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995037111",
            "telephone_number": "907-699-8581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANCY MOOSE ANCHORAGE ALH",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-12",
        "last_updated": "2014-01-12",
        "status": "A",
        "authorized_official_last_name": "DOBBS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "907-699-8581"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "AK",
            "license": "101034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.