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Organization
SOUTHCENTRAL FOUNDATION
Active
Organization
SOUTHCENTRAL FOUNDATION
Active
Other names
The Pathway Home Rendezvous
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD LEE OLSON (VP OF FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
4353 RENDEZVOUS CIR, ANCHORAGE, AK 99504-4219
(907) 729-5020
Mailing address
4501 DIPLOMACY DR, ATTN: PROVIDER ENROLLMENT, ANCHORAGE, AK 99508-5919
(907) 729-4955
Taxonomy
Speciality
Code
Description
License number
State
323P00000X
Psychiatric Residential Treatment Facility
Primary
20467
AK
Other
Enumeration date
06/27/2008
Last updated
01/28/2016
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