NPIMap

Organization Active NPI

Fairbanks Native Association

  • Substance Abuse Rehabilitation Facility
  • Fairbanks, AK
National Provider Identifier
1508401381
Registry record updated Nov 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
FAIRBANKS NATIVE ASSOCIATION
Practice address
3100 S Cushman St
Fairbanks, AK 99701-7516
Phone
(907) 452-6251
Fax
(907) 456-4849
NPI assigned
Nov 15, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2019

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

Authorized official

Name
Perry Ahsogeak
Title
Behavioral Health Director
Phone
(907) 452-6251

Specialties & licenses 1

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

Addresses

Primary practice location

3100 S Cushman St
Fairbanks, AK 99701-7516

Mailing address

315 Wendell Ave
Fairbanks, AK 99701-4837
Phone (907) 452-6251

Other identifiers 1

IdentifierTypeStateIssuer
1696809MedicaidAK

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

315 Wendell Ave
Fairbanks, AK 99701
Phone (907) 452-1648

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

NPI Registry JSON

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

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1573776000000",
    "number": "1508401381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 WENDELL AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014837",
            "telephone_number": "907-452-6251",
            "fax_number": "907-452-1001"
        },
        {
            "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": "2019-11-15",
        "last_updated": "2019-11-15",
        "status": "A",
        "authorized_official_last_name": "AHSOGEAK",
        "authorized_official_first_name": "PERRY",
        "authorized_official_title_or_position": "BEHAVIORAL HEALTH DIRECTOR",
        "authorized_official_telephone_number": "907-452-6251"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1696809",
            "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 Nov 15, 2019; 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.