NPIMap

Organization Active NPI

Old Minto Family Recovery Camp

  • Substance Abuse Rehabilitation Facility
  • Fairbanks, AK
National Provider Identifier
1982877353
Registry record updated Apr 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
License
246135 Issued in AK
Legal business name
OLD MINTO FAMILY RECOVERY CAMP
Practice address
122 1St Ave
Fairbanks, AK 99701-4803
Phone
(907) 452-8251
NPI assigned
Apr 8, 2008
Organization subpart
Yes
Parent organization
TANANA CHIEFS CONFERENCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2008

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

Authorized official

Name
Victor Joseph
Title
Health Services Director
Phone
(907) 452-8251

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Abuse Rehabilitation Facility 324500000X 246135 AK Primary

Addresses

Primary practice location

122 1St Ave
Fairbanks, AK 99701-4803

Mailing address

122 1St Ave
Fairbanks, AK 99701-4803

Other identifiers 1

IdentifierTypeStateIssuer
DA4380MedicaidAK

National Provider Directory

National Provider Directory
Tax ID family
Old Minto Family Recovery Camp38 organizations share this tax ID, including this one
Part of
Old Minto Family Recovery Camp

Other organizations with this tax ID 37

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

View all 37

Locations

122 1st Ave
Fairbanks, AK 99701
Phone (907) 452-6434

NPI Registry JSON

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

{
    "created_epoch": "1207612800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1982877353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 1ST AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 1ST AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014803",
            "telephone_number": "907-452-8251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MINTO FAMILY RECOVERY CAMP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TANANA CHIEFS CONFERENCE",
        "enumeration_date": "2008-04-08",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_title_or_position": "HEALTH SERVICES DIRECTOR",
        "authorized_official_telephone_number": "907-452-8251"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "AK",
            "license": "246135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DA4380",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 8, 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.