Healthcare Provider Details

I. General information

NPI: 1538521026
Provider Name (Legal Business Name): SOUTHEAST ALASKA REGIONAL HEALTH CONSTORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 KATLIAN ST STE E
SITKA AK
99835
US

IV. Provider business mailing address

3100 CHANNEL DR STE 300
JUNEAU AK
99801-7837
US

V. Phone/Fax

Practice location:
  • Phone: 907-747-5136
  • Fax: 907-747-5415
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 Number70206
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number70206
License Number StateAK

VIII. Authorized Official

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