| Sud 1115- Detox | |
|
4330 Elmore Rd Anchorage AK 99508-5907 | |
| (907) 729-6690 | |
| Not Available |
| Full Name | Sud 1115- Detox |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4330 Elmore Rd, Anchorage, Alaska |
| Authorized Official Name and Position | Ronald Lee Olson (EXECUTIVE VICE PRESIDENT FINANCE) |
| Authorized Official Contact | 9077294939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sud 1115- Detox Po Box 35198 Seattle WA 98124-5198 Ph: () - | Sud 1115- Detox 4330 Elmore Rd Anchorage AK 99508-5907 Ph: (907) 729-6690 |
| NPI Number | 1750934188 |
|---|---|
| Provider Enumeration Date | 07/24/2019 |
| Last Update Date | 09/14/2023 |
| Certification Date | 09/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750934188 | NPI | - | NPPES |
| 1696899 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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