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General NPI Number Information
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NPI Number | 1144830837
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Entity Type | Organization
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Legal Business Name | SOUTHCENTRAL FOUNDATION
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Dates
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Enumeration Date | 08/06/2020
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Last Update Date | 08/17/2020
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Provider Practice Location Address
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Address Line | 26341 EKLUTNA VILLAGE RD
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City | CHUGIAK
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State | AK
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Zip | 99567-5148
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Country | US
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Telephone | 907-688-6031
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Fax | 907-688-6021
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Provider Business Mailing Address
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Address Line | PO BOX 35198
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City | CHUGIAK
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State | AK
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Zip | 99567-5148
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Country | US
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Telephone | 907-688-6731
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Fax | 907-688-8607
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Authorized Official
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Title or Position | VP OF REVENUE
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Name | RONALD LEE OLSON
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Credential |
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Telephone | 701-729-4939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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