NPIMap

Organization Active NPI

Southcentral Foundation

Doing business as Care Coordination - Waiver Care Coordination

  • Case Management Agency
  • Anchorage, AK
National Provider Identifier
1164690459
Registry record updated Aug 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
License
20467 Issued in AK
Legal business name
SOUTHCENTRAL FOUNDATION
Doing business as
Care Coordination - Waiver Care Coordination
Practice address
4160 Tudor Centre Dr
Anchorage, AK 99508-5901
Phone
(907) 729-6365
NPI assigned
Feb 20, 2008
Last updated
Aug 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHCENTRAL FOUNDATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 31, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ronald Lee Olson
Title
Executive Vice President Finance
Phone
(907) 729-4939

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X 20467 AK Primary
Case Manager/Care Coordinator 171M00000X 20467 AK

Addresses

Primary practice location

4160 Tudor Centre Dr
Anchorage, AK 99508-5901

Mailing address

PO Box 35198
Seattle, WA 98124-5198

Other identifiers 1

IdentifierTypeStateIssuer
1002717MedicaidAK

Other names 1

  • Care Coordination - Waiver Care Coordination Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Southcentral Foundation Nikolai Health Center103 organizations share this tax ID, including this one
Part of
Southcentral Foundation Nikolai Health Center

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

4160 Tudor Centre Dr
Anchorage, AK 99508
Phone (907) 729-2490

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1164690459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 35198",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981245198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4160 TUDOR CENTRE DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085901",
            "telephone_number": "907-729-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2008-02-20",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "907-729-4939"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "AK",
            "license": "20467",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "AK",
            "license": "20467",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002717",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Care Coordination - Waiver Care Coordination",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Anchorage, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.