Organization
SOUTHCENTRAL FOUNDATION
Active
Parent organization
SOUTHCENTRAL FOUNDATION
Other names
Tribal- Nondalton 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
69 MAIN STREET, NONDALTON, AK 99640
(907) 294-2238
Mailing address
PO BOX 35198, SEATTLE, WA 98124-5198
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
20467
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1637739
—
AK
Enumeration date
09/16/2015
Last updated
09/14/2023
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