Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Intensive Home Based Treatment
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHCENTRAL FOUNDATION
Authorized official
JONA TETZLOFF (MANAGER OF REVENUE CYCLE)
(907) 729-5083
Entity
Organization
Contact information
Practice address
3000 C ST, ANCHORAGE, AK 99503-3975
(907) 729-8558
Mailing address
7033 E TUDOR RD, ANCHORAGE, AK 99507-1262
(907) 729-5083
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
10/30/2023
Last updated
10/30/2023
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