Organization
SOUTHCENTRAL FOUNDATION
Active
Other names
Diabetes Wellness Gathering Program
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD LEE OLSON (VP FINANCE)
(907) 729-4939
Entity
Organization
Contact information
Practice address
4201 TUDOR CENTRE DR, ATTN: DIABETES EDUCATION, ANCHORAGE, AK 99508-5904
(907) 729-4380
Mailing address
4501 DIPLOMACY DR, ATTN: PROVIDER ENROLLMENT, ANCHORAGE, AK 99508-5919
(907) 729-4955
Taxonomy
Speciality
Code
Description
License number
State
132700000X
Dietary Manager
Primary
20467
AK
Other
Enumeration date
01/05/2011
Last updated
01/28/2016
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