| Name: | Fairbanks Family Wellness, LLC |
| Jurisdiction: | Alaska |
| Legal type: | Limited Liability Company |
| Status: | Good Standing |
| Date of registration: | 27 Dec 2010 (14 years ago) |
| Entity Number: | 132251 |
| ZIP code: | 99709 |
| County: | Fairbanks North Star |
| Place of Formation: | ALASKA |
| Address: | 3550 AIRPORT WAY, #4, FAIRBANKS, AK 99709 |
Line of Business
62 Health Care and Social AssistanceNAICS
621498 ALL OTHER OUTPATIENT CARE CENTERS| Name | Role |
|---|---|
| Amy A. Williamson | Registered Agent |
| Amy Williamson | Member |
| Plan Name | Plan Year | EIN/PN | Received | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FAIRBANKS FAMILY WELLNESS 401(K) PLAN | 2023 | 611583020 | 2024-06-12 | 22 | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2024-06-12 |
| Name of individual signing | PHOENIX MANN |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Sponsor | FAIRBANKS FAMILY WELLNESS |
| Business code | 621399 |
| Sponsor’s telephone number | 9074792331 |
| Plan sponsor’s address | 3550 AIRPORT WAY, SUITE 4, FAIRBANKS, AK, 99709 |
Signature of
| Role | Plan administrator |
| Date | 2024-01-15 |
| Name of individual signing | PHOENIX MANN |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Sponsor | FAIRBANKS FAMILY WELLNESS |
| Business code | 621399 |
| Plan sponsor’s address | 3550 AIRPORT WAY, SUITE 4, FAIRBANKS, AK, 99709 |
Signature of
| Role | Plan administrator |
| Date | 2023-06-21 |
| Name of individual signing | PHOENIX TALLANT |
| Type | License Number | Status | Date of issue | Date of renewal | Expiration date | Description |
|---|---|---|---|---|---|---|
| Business License | 952620 | Active | 2010-12-30 | 2022-12-01 | 2024-12-31 | LOB: 62 - Health Care and Social Assistance, NAICS: 621399 - OFFICES OF ALL OTHER MISCELLANEOUS HEALTH PRACTITIONERS |
| Telemedicine Business Registry | 159440 | Active | 2020-03-24 | - | - | - |
Date of last update: 11 Jan 2025
Sources: State of Alaska - Department of Commerce, Community, and Economic Development
