Basic Information
| Provider Information | |||||||||
| NPI: | 1689822876 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAIRBANKS COMMUNITY BEHAVIORAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3830 S CUSHMAN ST | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997017530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074521575 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3830 S CUSHMAN ST | ||||||||
| Address2: | |||||||||
| City: | FAIRBANKS | ||||||||
| State: | AK | ||||||||
| PostalCode: | 997017530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074521575 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 09/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | ATCHISON | ||||||||
| AuthorizedOfficialFirstName: | GAIL | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9074521575 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 385HR2055X | N | Respite Care Facility | Respite Care | Respite Care, Mental Illness, Child | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
No ID Information.