Provider Demographics
NPI:1699003277
Name:FAIRBANKS RESOURCE AGENCY
Entity Type:Organization
Organization Name:FAIRBANKS RESOURCE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SENIOR SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:907-451-0389
Mailing Address - Street 1:805 AIRPORT WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6039
Mailing Address - Country:US
Mailing Address - Phone:907-456-8901
Mailing Address - Fax:907-452-5171
Practice Address - Street 1:117 SLATER DR
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-3427
Practice Address - Country:US
Practice Address - Phone:907-451-0389
Practice Address - Fax:907-451-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCM2000251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management