Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Tribal- Quyana Clubhouse
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
225 EAGLE ST, ANCHORAGE, AK 99501-2626
(907) 729-6550
Mailing address
PO BOX 35198, SEATTLE, WA 98124-5198
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
20467
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000855
—
AK
Enumeration date
06/13/2012
Last updated
09/13/2023
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