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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