Organization
SOUTHCENTRAL FOUNDATION
Active
Other names
Port Alsworth BSD Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD LEE OLSON (VP FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
1 FLIGHT LINE ROAD, PORT ALSWORTH, AK 99653
(907) 729-4955
Mailing address
4501 DIPLOMACY DR, ANCHORAGE, AK 99508-5919
(907) 729-4955
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
20467
AK
Other
Enumeration date
02/04/2016
Last updated
03/15/2016
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