Organization
SOUTHCENTRAL FOUNDATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD LEE OLSON (VP OF FINANCE)
(907) 729-8624
Entity
Organization
Contact information
Practice address
1001 S KNIK GOOSE BAY RD, WASILLA, AK 99654-8083
(907) 729-8624
Mailing address
4501 DIPLOMACY DR, ANCHORAGE, AK 99508-5919
(907) 729-8624
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
20467
AK
Other
Enumeration date
06/23/2017
Last updated
06/23/2017
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