Provider Demographics
NPI:1144830837
Name:SOUTHCENTRAL FOUNDATION
Entity type:Organization
Organization Name:SOUTHCENTRAL FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-729-4939
Mailing Address - Street 1:PO BOX 35198
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-5148
Mailing Address - Country:US
Mailing Address - Phone:907-688-6731
Mailing Address - Fax:907-688-8607
Practice Address - Street 1:26341 EKLUTNA VILLAGE RD
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-5148
Practice Address - Country:US
Practice Address - Phone:907-688-6031
Practice Address - Fax:907-688-6021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health