Healthcare Provider Details

I. General information

NPI: 1215454137
Provider Name (Legal Business Name): SOUTH EAST ALASKA REAGIONAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CHURCH STREET
WRANGELL AK
99929
US

IV. Provider business mailing address

3100 CHANNEL DR STE 300
JUNEAU AK
99801-7837
US

V. Phone/Fax

Practice location:
  • Phone: 907-874-3375
  • Fax: 907-874-3339
Mailing address:
  • Phone: 907-463-4074
  • Fax: 907-463-1510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1677221
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer
# 2
Identifier70206
Identifier TypeOTHER
Identifier StateAK
Identifier IssuerSTATE OF ALASKA

VIII. Authorized Official

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