OLD MINTO FAMILY RECOVERY CAMP (NPI# 1982877353) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982877353 |
| Entity Type | Organization |
| Organization Name | OLD MINTO FAMILY RECOVERY CAMP |
| Practice Address |
122 1st Ave Fairbanks AK 99701-4803 |
| Practice Telephone | 9074528251 |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2008-04-08 |
| Authorized Official Name | VICTOR JOSEPH (HEALTH SERVICES DIRECTOR) |
| Authorized Official Telephone | 9074528251 |
| Is Organization Subpart | Y |
| Parent Organization Name | TANANA CHIEFS CONFERENCE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 324500000X | Substance Abuse Rehabilitation Facility | 246135 | AK | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | DA4380 | 05 |
| Street Address |
122 1ST AVE |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99701-4803 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558359323 | Kathleen Hodges | Social Worker | 122 1st Ave, Fairbanks, AK 99701-4803 | 2005-10-06 |
| 1447801857 | John Gerald Mayo | Counselor | 122 1st Ave, Fairbanks, AK 99701-4871 | 2019-09-26 |
| 1619227246 | Qwynten Richards | Counselor | 122 1st Ave, Suite 400, Fairbanks, AK 99701-4803 | 2012-09-11 |
| 1750639449 | Sandra Mccafferty | Community Health Worker | 122 1st Ave, Suie 600, Fairbanks, AK 99701-4803 | 2012-08-28 |
| 1407104169 | Alfred Stevens | Counselor | 122 1st Ave, Suite 600, Fairbanks, AK 99701-4803 | 2012-08-28 |
| 1710234877 | Michael James Demoski | Dental Assistant | 122 1st Ave, 600, Fairbanks, AK 99701-4803 | 2012-08-08 |
| 1023365186 | Debra Ann Dayton | Dental Assistant | 122 1st Ave, 600, Fairbanks, AK 99701-4803 | 2012-08-08 |
| 1699021600 | Mary Beth Morrison | Case Manager/Care Coordinator | 122 1st Ave, 4th Floor, Fairbanks, AK 99701-4803 | 2012-07-27 |
| 1598011512 | Jennie Lynn Mclean | Case Manager/Care Coordinator | 122 1st Ave, Fourth Floor, Fairbanks, AK 99701-4803 | 2012-07-27 |
| 1497001416 | Pearl J Gould | Case Manager/Care Coordinator | 122 1st Ave, Fourth Floor, Fairbanks, AK 99701-4803 | 2012-07-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659984987 | Resource Center for Parents & Children, Inc. | Social Worker | 726 26th Ave, Suite #2, Fairbanks, AK 99701 | 2020-08-26 |
| 1134738982 | Aaron Paul Sarauer | Behavior Technician | 3121 Lathrop St., Fairbanks, AK 99701 | 2020-07-28 |
| 1437715505 | Fabienne Rose Marie Siddall | Case Manager/Care Coordinator | 122 1st Avenue, Fairbanks, AK 99701 | 2019-05-14 |
| 1902461957 | Jacqueline Marie Rahm | Counselor | Family Centered Services of Alaska - Rtc, 3101 Lathrop St., Fairbanks, AK 99701 | 2019-05-06 |
| 1821588989 | Corrie Wilson | Nurse Practitioner | 1025 Barnette Street, Fairbanks, AK 99701 | 2018-05-15 |
| 1922519305 | Sarishma Sangeeta Lal | Registered Nurse | 815 2nd Ave Ste 122, Fairbanks, AK 99701 | 2017-10-12 |
| 1245690569 | Christine L Simko | Naturopath | 1275 Sadler Way, Ste 100 Rm 147, Fairbanks, AK 99701 | 2016-02-29 |
| 1932581600 | Jennifer Davis | Registered Nurse | 1025 West Barnette St., Fairbanks, AK 99701 | 2015-06-18 |
| 1700272705 | John D. Zipperer Jr Md, LLC | Clinic/Center | 751 Old Richardson Hwy., Fairbanks, AK 99701 | 2015-04-07 |
| 1578957460 | Mara Justine Becker | Physician Assistant | 1717 W. Cowles St, Fairbanks, AK- ALASKA 99701 | 2015-03-27 |
| Find all providers in zip 99701 | ||||
| Taxonomy Code | 324500000X |
| Grouping | Residential Treatment Facilities |
| Classification | Substance Abuse Rehabilitation Facility |
| A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances. |
| Notes: [7/1/2003: modified title, modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508393869 | Ground Zero Wellness Center | Substance Abuse Rehabilitation Facility | 4670 Killen Ln, Fairbanks, AK 99709-3325 | 2017-05-17 |
| 1508401381 | Fairbanks Native Association | Substance Abuse Rehabilitation Facility | 3100 S Cushman St, Fairbanks, AK 99701-7516 | 2019-11-15 |
| 1134764913 | Fairbanks Native Association | Substance Abuse Rehabilitation Facility | 650 Younker Ct, Fairbanks, AK 99701-7586 | 2019-11-15 |
| 1790236578 | North Country Medical, LLC | Substance Abuse Rehabilitation Facility | 626 2nd St, Suite 201b, Fairbanks, AK 99701-3466 | 2016-10-17 |
| 1275897548 | Steven Ketzler | Substance Abuse Rehabilitation Facility | 122 1st Ave, Suite 600, Fairbanks, AK 99701-4803 | 2012-07-01 |
| 1013205608 | Tanana Chiefs Conference | Substance Abuse Rehabilitation Facility | 201 1st Ave, Fairbanks, AK 99701-4848 | 2011-07-15 |
| 1386817237 | Fairbanks Native Association | Substance Abuse Rehabilitation Facility | 2550 Lawlor Rd, Fairbanks, AK 99709-6458 | 2008-04-10 |
| 1154594216 | Fairbanks Native Association | Substance Abuse Rehabilitation Facility | 3100 S Cushman St, Fairbanks, AK 99701-7516 | 2008-04-10 |
| 1578736211 | Fairbanks Native Association | Substance Abuse Rehabilitation Facility | 1027 Evergreen St, Fairbanks, AK 99709-4306 | 2008-04-02 |
| 1982876629 | Fairbanks Native Association | Substance Abuse Rehabilitation Facility | 2550 Lawlor Rd, Fairbanks, AK 99709-6458 | 2008-04-01 |
| Find all providers in FAIRBANKS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.