Healthcare Provider Details

I. General information

NPI: 1932184298
Provider Name (Legal Business Name): SOUTH EAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 1ST STREET SOUTH
HAINES AK
99827
US

IV. Provider business mailing address

222 TONGASS DR
SITKA AK
99835-9416
US

V. Phone/Fax

Practice location:
  • Phone: 907-766-6300
  • Fax: 907-766-2675
Mailing address:
  • Phone: 907-966-2411
  • Fax: 907-966-8606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number70206
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

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