Southcentral Foundation

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SOUTHCENTRAL FOUNDATION

Doing business as

BH 1115- Nondalton

Practice address

69 Main Street
Nondalton, AK 99640

Phone

(907) 294-2238

NPI assigned

Nov 19, 2020

Last updated

Sep 14, 2023By 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 1

Addresses

Other identifiers 1

Other names 1

• BH 1115- Nondalton Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Southcentral Foundation Nikolai Health Center

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Erin Callahan, ANP, RN

  • Psychiatric/Mental Health Nurse Practitioner
  • Anchorage, AK
  • NPI 1215131156
  NPD
• Rebekah Ellen Keene, LCSW

  • Clinical Social Worker
  • Anchorage, AK
  • NPI 1750948071
  NPD
• Cheryl Lynn Kious, LPC, CDC II

  • Professional Counselor
  • Anchorage, AK
  • NPI 1326397266
  NPD
• Christopher D. Wightman, LCSW

  • Clinical Social Worker
  • Anchorage, AK
  • NPI 1740337864
  NPD

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

{
    "created_epoch": "1605744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1639772882",
    "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": "69 MAIN STREET",
            "city": "NONDALTON",
            "state": "AK",
            "postal_code": "99640",
            "telephone_number": "907-294-2238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHCENTRAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
        "enumeration_date": "2020-11-19",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1716557",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BH 1115- Nondalton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Karina A Jeffries, CHA III
• Southcentral Foundation (Dental- Nondalton Dental Clinic)
• Southcentral Foundation (Tribal- Nondalton Clinic)
• Gloria M Trefon

• Community/Behavioral Health Agency in Nondalton, AK
• Providers in Nondalton, AK by specialty
• Community/Behavioral Health Agency in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2023; 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.