| 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 |
| Supporting healthcare providers fighting with COVID-19: | $2,019 |
Line of Business
62 Health Care and Social AssistanceNAICS
621498 ALL OTHER OUTPATIENT CARE CENTERS| Name | Role |
|---|---|
| Amy Williamson | Member |
| Amy A. Williamson | Registered Agent |
| 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 |
| License Number | Type | Status | Issue Date | Date of renewal | Expiration date | Description |
|---|---|---|---|---|---|---|
| 952620 | Business License | Active | 2010-12-30 | 2024-11-07 | 2026-12-31 | LOB: 62 - Health Care and Social Assistance, NAICS: 621498 - ALL OTHER OUTPATIENT CARE CENTERS |
| License Number | Program | Type | Status | Issue Date | Effective Date | Expiration Date |
|---|---|---|---|---|---|---|
| 159440 | Telemedicine Business Registry | Telemedicine Business Registry | Active | 2020-03-24 | 2020-03-24 | - |
| Inspection Nr | Report ID | Date Opened | Site Address | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 346015423 | 1050210 | 2022-06-09 | 3550 AIRPORT WAY SUITE 4, FAIRBANKS, AK, 99709 | |||||||||
|
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Date of last update: 24 Jan 2025
Sources: State of Alaska - Department of Commerce, Community, and Economic Development
