1578736211 NPI number — FAIRBANKS NATIVE ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578736211 NPI number — FAIRBANKS NATIVE ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAIRBANKS NATIVE ASSOCIATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WOMEN AND CHILDREN'S CENTER FOR INNER HEALING
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578736211
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 WENDELL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99701-4837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-452-6251
Provider Business Mailing Address Fax Number:
907-452-1001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1027 EVERGREEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99709-4306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-451-8164
Provider Business Practice Location Address Fax Number:
907-456-4849
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AHSOGEAK
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
BHS DIRECTOR
Authorized Official Telephone Number:
907-452-6251

Provider Taxonomy Codes

  • Taxonomy code: 324500000X , with the licence number:  76821 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1696805 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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