Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
BSD- FASD Clinic
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
4341 TUDOR CENTRE DR, ANCHORAGE, AK 99508-5904
(907) 729-2500
Mailing address
PO BOX 35198, SEATTLE, WA 98124-5198
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
20467
AK
261QM1300X
Multi-Specialty Clinic/Center
Primary
20467
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000808
—
AK
Enumeration date
01/11/2008
Last updated
04/24/2024
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