| Southcentral Foundation | |
|
11495 N Callison St Sutton AK 99674 | |
| (907) 745-0704 | |
| (907) 729-8607 |
| Full Name | Southcentral Foundation |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 11495 N Callison St, Sutton, Alaska |
| Authorized Official Name and Position | Ronald Lee Olson (VP OF FINANCE) |
| Authorized Official Contact | 7017294939 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southcentral Foundation 7033 E Tudor Rd Anchorage AK 99507-1262 Ph: (907) 729-5418 | Southcentral Foundation 11495 N Callison St Sutton AK 99674 Ph: (907) 745-0704 |
| NPI Number | 1407466204 |
|---|---|
| Provider Enumeration Date | 08/06/2020 |
| Last Update Date | 08/06/2020 |
| Certification Date | 08/06/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407466204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
Bh 1115- Lifehouse Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11495 N. Callison Street, Sutton, AK 99674 Phone: 907-631-7665 |