GAVIN HAGE (NPI# 1053952960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053952960 |
| Entity Type | Individual |
| Full Name | GAVIN HAGE |
| Practice Address |
3101 Lathrop St Fairbanks AK 99701-7426 |
| Mailing Address |
1825 Marika Rd Fairbanks AK 99709-5521 |
| Practice Telephone | 9074594700 |
| Mailing Telephone | 9074740890 |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-10-02 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| Street Address |
3101 LATHROP ST |
| City | FAIRBANKS |
| State | AK |
| Zip Code | 99701-7426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609088491 | Ted Campbell | Counselor | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2007-05-04 |
| 1164029161 | Amanda Young | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-10-03 |
| 1699372623 | Iesha Nicole Little-robinson | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-10-02 |
| 1730786765 | Victor Ramon Pichardo Nunez | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-10-02 |
| 1467059493 | Alissa Merrily Allen | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-10-02 |
| 1053918078 | Abigail Scott | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-10-02 |
| 1326657412 | Eric Enlow | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-07-24 |
| 1659980746 | Alisha Gail | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-07-24 |
| 1467061564 | Anjoli D. Anderson | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-07-24 |
| 1609485796 | Brionna Leigh Yannello | Behavior Technician | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2020-07-24 |
| 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 | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447895578 | Tanana Chiefs Conference | Community/Behavioral Health | 117 1st Ave, Fairbanks, AK 99701-4802 | 2019-11-13 |
| 1497390538 | Tanana Chiefs Conference | Community/Behavioral Health | 122 1st Ave Ste 106, Fairbanks, AK 99701-4871 | 2019-11-13 |
| 1336614205 | Extended Family Alaska LLC | Community/Behavioral Health | 978 Pickering Dr, Fairbanks, AK 99709-5770 | 2018-10-08 |
| 1316247091 | North Star Council On Aging, Inc. | Community/Behavioral Health | 1424 Moore St, Fairbanks, AK 99701-5716 | 2010-10-27 |
| 1881713261 | Interior Aids Association | Community/Behavioral Health | 710 3rd Ave, Fairbanks, AK 99701-4455 | 2007-03-28 |
| 1912079088 | Fairbanks Resource Agency Inc | Community/Behavioral Health | 805 Airport Road, Fairbanks, AK 99701 | 2006-11-14 |
| 1841835980 | Tanana Chiefs Conference | Community/Behavioral Health | 1521 S Cushman St, Fairbanks, AK 99701-6203 | 2019-11-13 |
| 1306481437 | Tanana Chiefs Conference | Community/Behavioral Health | 1717 W Cowles St, Fairbanks, AK 99701-5926 | 2019-11-13 |
| 1053955674 | Tanana Chiefs Confenerce | Community/Behavioral Health | 1300 Moore St, Fairbanks, AK 99701-5761 | 2019-11-06 |
| 1083258677 | Chief Andrew Issac Health Center | Community/Behavioral Health | 1717 W Cowles St, Fairbanks, AK 99701-5926 | 2019-11-06 |
| 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.