| Fairbanks Resource Agency Inc | |
|
805 Airport Road Fairbanks AK 99701 | |
| (907) 456-8901 | |
| (907) 452-5171 |
| Full Name | Fairbanks Resource Agency Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 805 Airport Road, Fairbanks, Alaska |
| Authorized Official Name and Position | Emily Faye Ennis (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 9074568901 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairbanks Resource Agency Inc 805 Airport Road Fairbanks AK 99701 Ph: (907) 456-8901 | Fairbanks Resource Agency Inc 805 Airport Road Fairbanks AK 99701 Ph: (907) 456-8901 |
| NPI Number | 1912079088 |
|---|---|
| Provider Enumeration Date | 11/14/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912079088 | NPI | - | NPPES |
| HC5250 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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