Healthcare Provider Details

I. General information

NPI: 1497479836
Provider Name (Legal Business Name): SOUTHEAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2022
Last Update Date: 09/29/2022
Certification Date: 09/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KATLIAN STREET STE F
SIKA AK
99801
US

IV. Provider business mailing address

3100 CHANNEL DR STE 300
JUNEAU AK
99801-7837
US

V. Phone/Fax

Practice location:
  • Phone: 907-966-9797
  • Fax: 907-966-9796
Mailing address:
  • Phone: 907-463-4074
  • Fax: 907-463-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
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 OF ALASKA

VIII. Authorized Official

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