NPIMap

Organization Active NPI

Fairbanks Native Association

Doing business as Ralph Perdue Center

  • Substance Abuse Rehabilitation Facility
  • Fairbanks, AK
National Provider Identifier
1154594216
Registry record updated Apr 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
76821 Issued in AK
Legal business name
FAIRBANKS NATIVE ASSOCIATION
Doing business as
Ralph Perdue Center
Practice address
3100 S Cushman St
Fairbanks, AK 99701-7516
Phone
(907) 452-6251
Fax
(907) 456-4849
NPI assigned
Apr 10, 2008
Last updated
Apr 10, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 10, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Guy M Patterson
Title
BHS Director
Phone
(907) 452-6251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 76821 AK Primary

Addresses

Primary practice location

3100 S Cushman St
Fairbanks, AK 99701-7516

Mailing address

605 Hughes Ave
Fairbanks, AK 99701-7539
Phone (907) 452-1648

Other identifiers 1

IdentifierTypeStateIssuer
DA4435MedicaidAK

Other names 1

  • Ralph Perdue Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fairbanks Native Association6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3100 S Cushman St
Fairbanks, AK 99701
Phone (907) 452-1648

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1207785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207785600000",
    "number": "1154594216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 HUGHES AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997017539",
            "telephone_number": "907-452-1648",
            "fax_number": "907-456-4849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 S CUSHMAN ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997017516",
            "telephone_number": "907-452-6251",
            "fax_number": "907-456-4849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRBANKS NATIVE ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-10",
        "last_updated": "2008-04-10",
        "status": "A",
        "authorized_official_last_name": "PATTERSON",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BHS DIRECTOR",
        "authorized_official_telephone_number": "907-452-6251"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AK",
            "license": "76821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA4435",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ralph Perdue Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.