Organization · Type 2 NPI

Southcentral Foundation

Community Health Clinic/Center · Sutton, AK

NPI number 1043632037 Active

Practice location

11495 N Callison Street
Sutton, AK 99674

Call (907) 631-7665 Map

Mailing address

PO Box 35198
Seattle, WA 98124-5198

Specialties and licenses

Taxonomy	Code	License
Community Health Clinic/Center Primary	261QC1500X	20467 (AK)

Community Health Clinic/Center: Definition to come...

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Chickaloon Native VilllageCommunity Health Clinic/Center Sutton, AK NPI 1619267937

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NPI record

NPI: 1043632037
Entity type: Organization (Type 2)
Issued: Jan 10, 2014
Last updated: Aug 30, 2023
Status: Active
Subpart: Yes of Southcentral Foundation

Other names

<unavail>
Tribal- Life House Community Health Center · doing business as

Authorized official

Ronald Lee Olson
Executive Vice President of Finance
(907) 729-4939

Verify this record

This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1043632037

Southcentral Foundation's National Provider Identifier is 1043632037, issued on Jan 10, 2014. The primary taxonomy on file is Community Health Clinic/Center (261QC1500X), and the practice location is in Sutton, AK. The record was last updated on Aug 30, 2023.