| Bh 1115- Lifehouse | |
|
11495 N. Callison Street Sutton AK 99674 | |
| (907) 631-7665 | |
| Not Available |
| Full Name | Bh 1115- Lifehouse |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11495 N. Callison Street, Sutton, 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 |
|---|---|
| Bh 1115- Lifehouse Po Box 35198 Seattle WA 98124-5198 Ph: () - | Bh 1115- Lifehouse 11495 N. Callison Street Sutton AK 99674 Ph: (907) 631-7665 |
| NPI Number | 1588255970 |
|---|---|
| Provider Enumeration Date | 01/29/2021 |
| Last Update Date | 09/14/2023 |
| Certification Date | 09/14/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588255970 | NPI | - | NPPES |
| 1716563 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
Southcentral Foundation Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 11495 N Callison St, Sutton, AK 99674 Phone: 907-745-0704 Fax: 907-729-8607 |