Healthcare Provider Details

I. General information

NPI: 1962033282
Provider Name (Legal Business Name): FAMILY CENTERED SERVICES OF ALASKA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 MARIKA RD
FAIRBANKS AK
99709-5521
US

IV. Provider business mailing address

1825 MARIKA RD
FAIRBANKS AK
99709-5521
US

V. Phone/Fax

Practice location:
  • Phone: 907-474-0890
  • Fax: 907-474-3621
Mailing address:
  • Phone: 907-474-0890
  • Fax: 907-474-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALLISON J BENJAMIN
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 907-474-0890