| Extended Family Alaska Llc | |
|
978 Pickering Dr Fairbanks AK 99709-5770 | |
| (907) 205-7427 | |
| Not Available |
| Full Name | Extended Family Alaska Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 978 Pickering Dr, Fairbanks, Alaska |
| Authorized Official Name and Position | Deon Burns (PRESIDENT) |
| Authorized Official Contact | 9072057427 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Extended Family Alaska Llc 12725 Landmark St # A Anchorage AK 99515-3818 Ph: (907) 205-7427 | Extended Family Alaska Llc 978 Pickering Dr Fairbanks AK 99709-5770 Ph: (907) 205-7427 |
| NPI Number | 1336614205 |
|---|---|
| Provider Enumeration Date | 10/08/2018 |
| Last Update Date | 10/08/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336614205 | NPI | - | NPPES |
| 101264 | Other | AK | ASSISTED LIVING HOME LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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