Healthcare Provider Details

I. General information

NPI: 1710465935
Provider Name (Legal Business Name): SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 COLD STORAGE RD SUITE 203
CRAIG AK
99921
US

IV. Provider business mailing address

3100 CHANNEL DR STE 300
JUNEAU AK
99801-7837
US

V. Phone/Fax

Practice location:
  • Phone: 907-755-4800
  • Fax:
Mailing address:
  • Phone: 907-463-4074
  • Fax: 907-463-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier70206
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerSTATE LICENSE
# 2
Identifier1695127
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DANIEL HARRIS
Title or Position: VP/CHIEF FINANCIAL OFFICER
Credential:
Phone: 907-463-4000