Organization
SOUTHCENTRAL FOUNDATION
Active
Organization
SOUTHCENTRAL FOUNDATION
Active
Other names
BH 1115- St Paul Community Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD L OLSON (VP FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
1000 POLOVINA TURNPIKE, ST PAUL, AK 99660
(907) 546-2310
Mailing address
4501 DIPLOMACY DR, ATTN: PROVIDER ENROLLMENT SERVICES, ANCHORAGE, AK 99508-5919
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
11/26/2014
Last updated
07/12/2024
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