Active NPI
Southcentral Foundation
- Community/Behavioral Health Agency
- Anchorage, AK
National Provider Identifier
1750934188
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Behavioral Health Agency
- Legal business name
- SOUTHCENTRAL FOUNDATION
- Doing business as
- SUD 1115- Detox
- Practice address
- 4330 Elmore Rd
Anchorage, AK 99508-5907 - Phone
- (907) 729-6690
- NPI assigned
- Jul 24, 2019
- Organization subpart
- Yes
- Parent organization
- SOUTHCENTRAL FOUNDATION
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Behavioral Health Agency | 251S00000X | Primary |
Addresses
Primary practice location
4330 Elmore Rd
Anchorage, AK 99508-5907
Mailing address
PO Box 35198
Seattle, WA 98124-5198
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1696899 | Medicaid | AK |
Other names 1
- SUD 1115- Detox
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051027000416 | TX | Part B Supplier - Clinic/Group Practice | 5496663627 |
Receives reassigned benefits from 534 practitioners This NPI is an additional NPI on the enrollment Practice locations: Anchorage, AK; Chugiak, AK; Fairbanks, AK; Igiugig, AK; Iliamna, AK; Kockhanok, AK; McGrath, AK; Nondalton, AK… |
National Provider Directory
National Provider Directory- Part of
- Anchorage Primary Care Clinic
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563926400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1694649600000",
"number": "1750934188",
"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": "4330 ELMORE RD",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995085907",
"telephone_number": "907-729-6690"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHCENTRAL FOUNDATION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOUTHCENTRAL FOUNDATION",
"enumeration_date": "2019-07-24",
"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": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1696899",
"state": "AK"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "SUD 1115- Detox",
"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 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.