Healthcare Provider Details

I. General information

NPI: 1215913801
Provider Name (Legal Business Name): SOUTH EAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 KLAWOCK-HOLLIS HWY
KLAWOCK AK
99925-0069
US

IV. Provider business mailing address

3100 CHANNEL DRIVE STE 300
JUNEAU AK
99801
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 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