OrganizationActive
Branching Out Supported Services LLC
NPI 1942785464 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Fairbanks, AK
Provider details
- NPI number
- 1942785464
- Entity type
- Organization
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Organization subpart
- No
- Authorized official
- Glenn Wrightsman, Executive Director(907) 987-9267
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000X
Residential Treatment Facilities
Profile Score
Established profile(67/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
7 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1584 Hilton Ave
Fairbanks, AK 99701-4016
Phone: (907) 987-9267
Street-level locationGet directions
Mailing address
1584 Hilton Ave
Fairbanks, AK 99701-4016
Registry dates
- Enumerated
- 2018-10-01
- Last updated
- 2022-11-22
- Certified
- 2022-11-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.