Provider Demographics
NPI:1023445871
Name:FAIRBANKS COMMUNITY MENTAL HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:FAIRBANKS COMMUNITY MENTAL HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARCIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:BAS, CPC
Authorized Official - Phone:907-563-1000
Mailing Address - Street 1:1423 PEGER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-5169
Mailing Address - Country:US
Mailing Address - Phone:907-371-1300
Mailing Address - Fax:907-371-1386
Practice Address - Street 1:3830 S CUSHMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-7530
Practice Address - Country:US
Practice Address - Phone:907-452-1575
Practice Address - Fax:907-455-5287
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANCHORAGE COMMUNITY MENTAL HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-10
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1596091Medicaid