Southcentral Foundation

NPI #1205138294 in Wasilla, Alaska

Provider Information

NPI Number: 1205138294
Entity Type: Organization
Organization Name: Southcentral Foundation
Subpart: Yes (part of a larger organization)
Parent Organization: SOUTHCENTRAL FOUNDATION
Primary Specialty: Clinic/Center - Mental Health (Including Community Mental Health Center)
Enumeration Date: Nov 23, 2010
Last Updated: Aug 31, 2023

Practice Location

Address: 1001 S KNIK GOOSE BAY RD
City: Wasilla
State: Alaska
ZIP Code: 99654-8083
Phone: (907) 631-7800

Authorized Official

Name: RONALD LEE OLSON
Title: EXECUTIVE VICE PRESIDENT FINANCE
Phone: (907) 729-4939

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center)	261QM0801X	Primary

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