Southcentral Foundation

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

License

20467 Issued in AK

Legal business name

SOUTHCENTRAL FOUNDATION

Doing business as

BSD- FASD Clinic

Practice address

4341 Tudor Centre Dr
Anchorage, AK 99508-5904

Phone

(907) 729-2500

NPI assigned

Jan 11, 2008

Last updated

Apr 24, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

SOUTHCENTRAL FOUNDATIONAs reported in NPPES

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

Addresses

Other identifiers 1

Other names 1

• BSD- FASD Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Southcentral Foundation Nikolai Health Center

Locations

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713916800000",
    "number": "1255517975",
    "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": "4341 TUDOR CENTRE DR",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085904",
            "telephone_number": "907-729-2500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2008-01-11",
        "last_updated": "2024-04-24",
        "certification_date": "2024-04-24",
        "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": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "AK",
            "license": "20467",
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "AK",
            "license": "20467",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000808",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BSD- FASD Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Southcentral Foundation
• Southcentral Foundation (Intensive Home Based Treatment)
• Southcentral Foundation (Dental- Children's Dental Clinic)
• Southcentral Foundation (SUD 1115- 4 Directions)
• Southcentral Foundation (HPG- Chap Group)
• Southcentral Foundation (BSD- Detox)
• Southcentral Foundation (BH 1115- Icm)
• Southcentral Foundation (BH- PCC)
• Southcentral Foundation (Tribal- Centennial Center Clinic)
• Southcentral Foundation (Dental- Fireweed Dental Clinic)

• Multi-Specialty Clinic/Center in Anchorage, AK
• Providers in Anchorage, AK by specialty
• Multi-Specialty Clinic/Center in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.