Provider Demographics
NPI:1013684414
Name:FAIRBANKS COMMUNITY CARE COORDINATION
Entity type:Organization
Organization Name:FAIRBANKS COMMUNITY CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-398-7297
Mailing Address - Street 1:PO BOX 80929
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-0929
Mailing Address - Country:US
Mailing Address - Phone:907-398-7297
Mailing Address - Fax:
Practice Address - Street 1:1902 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-4223
Practice Address - Country:US
Practice Address - Phone:907-398-7297
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management