Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
SUD 1115- Benteh Nuutah Four Directions
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHCENTRAL FOUNDATION
Authorized official
RONALD LEE OLSON (EXECUTIVE VICE PRESIDENT FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
3223 E PALMER WASILLA HWY, WASILLA, AK 99654-7277
(907) 729-6300
Mailing address
PO BOX 35198, SEATTLE, WA 98124-5198
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1724999
—
AK
Enumeration date
05/27/2021
Last updated
08/30/2023
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