Provider Demographics
NPI:1447847934
Name:FAIRBANKS NATIVE ASSOCIATION
Entity type:Organization
Organization Name:FAIRBANKS NATIVE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:FONGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-452-6251
Mailing Address - Street 1:315 WENDELL AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-4837
Mailing Address - Country:US
Mailing Address - Phone:907-452-6251
Mailing Address - Fax:
Practice Address - Street 1:714 4TH AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4470
Practice Address - Country:US
Practice Address - Phone:907-452-6251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility