SOUTHCENTRAL FOUNDATION (NPI# 1043632037) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043632037 |
| Entity Type | Organization |
| Organization Name | SOUTHCENTRAL FOUNDATION |
| Other Organization Name | LIFE HOUSE CLINIC |
| Practice Address |
11495 N Callison Street Sutton AK 99674 |
| Mailing Address |
4501 Diplomacy Dr Attn: Provider Enrollment Anchorage AK 99508-5919 |
| Practice Telephone | 9077450704 |
| Mailing Telephone | 9077294955 |
| Enumeration Date | 2014-01-10 |
| Last Update Date | 2016-03-15 |
| Authorized Official Name | RONALD LEE OLSON (VP OF FINANCE) |
| Authorized Official Telephone | 9077294939 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
20467 | AK | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Life House Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407466204 | Southcentral Foundation | Clinic/Center | 11495 N Callison St, Sutton, AK 99674 | 2020-08-06 |
| 1528600947 | Southcentral Foundation | Clinic/Center | 6901 E Tudor Rd Ste 8, Anchorage, AK 99507-1254 | 2019-10-17 |
| 1639722069 | Southcentral Foundation | Community/Behavioral Health | 4175 Tudor Centre Dr, Anchorage, AK 99508-5917 | 2019-07-24 |
| 1659924025 | Southcentral Foundation | Community/Behavioral Health | 4341 Tudor Centre Dr Ste 300, Anchorage, AK 99508-5904 | 2019-07-24 |
| 1720548035 | Southcentral Foundation | Clinic/Center | 4441 Diplomacy Dr Fl 5, Anchorage, AK 99508-5910 | 2019-03-22 |
| 1750854089 | Southcentral Foundation | Clinic/Center | 400 W Benson Blvd, Anchorage, AK 99503-3829 | 2019-01-09 |
| 1639652662 | Southcentral Foundation | Clinic/Center | 26341 Eklutna Village Rd, Chugiak, AK 99567-5148 | 2018-09-14 |
| 1811420391 | Southcentral Foundation | Clinic/Center | 1021 E 3rd Ave, Anchorage, AK 99501-6102 | 2017-04-11 |
| 1043767940 | Southcentral Foundation | Dentist | 11495 N. Callison Street, Sutton, AK 99674 | 2016-09-08 |
| 1689021776 | Southcentral Foundation | Clinic/Center | 755 A St, Anchorage, AK 99501-3625 | 2016-05-18 |
| Street Address |
11495 N CALLISON STREET |
| City | SUTTON |
| State | AK |
| Zip Code | 99674 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407466204 | Southcentral Foundation | Clinic/Center | 11495 N Callison St, Sutton, AK 99674 | 2020-08-06 |
| 1043767940 | Southcentral Foundation | Dentist | 11495 N. Callison Street, Sutton, AK 99674 | 2016-09-08 |
| 1275629339 | Jon Todd Baughman | Physician Assistant | 11495 Callison Street, Life House Community Health Center, Sutton, AK 99674-0000 | 2006-10-05 |
| 1528335528 | Pauline Ann Richard | Social Worker | 12159 N. Jonesville Mine Rd., Sutton, AK 99674-0132 | 2011-11-19 |
| 1619267937 | Chickaloon Native Villlage | Clinic/Center | 16166 North Glen Highway, Mile 61.5 Glen Highway, Sutton, AK 99674-1105 | 2011-04-08 |
| 1184122772 | Rhoda Myers | Case Manager/Care Coordinator | 38922 N Glenn Hwy, Sutton, AK 99674-8008 | 2018-01-29 |
| 1982068169 | Alexis Althens | Legal Medicine | 34746 W Gamway Dr, Sutton, AK 99674-8233 | 2016-04-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194325894 | Amy Elizabeth Taylor | Pharmacist | 369 Scotts Fork Bonnie Road, Sutton, WV 26601 | 2020-10-30 |
| 1629678438 | David B Smith | Pharmacist | 369 Scotts Fork-bonnie Road, Sutton, WV 26601 | 2020-10-30 |
| 1720688070 | Anne Marie Kaminski | Social Worker | 83 Wheelock Rd, C/o Anne Kaminski, Sutton, MA 01590-2431 | 2020-10-27 |
| 1306446646 | Cathy Sue Cottrell | Homemaker | 101 2nd St Ste 201, Sutton, WV 26601-1303 | 2020-10-27 |
| 1518566546 | Amanda Faye Moore | Technician | 609 Poplar Ridge Rd, Sutton, WV 26601-3851 | 2020-10-21 |
| 1245837582 | Martha Elaine Asbury | Technician | 365 Peaceful Holw, Sutton, WV 26601-8789 | 2020-10-08 |
| 1164039061 | Andrea Jo Tanner | Nurse Practitioner | 266 Skidmore Ln, Sutton, WV 26601-9271 | 2020-09-25 |
| 1952914194 | Charlotte Ann Coffman | Technician | 42 Ashley Pl, Lot 2, Sutton, WV 26601 | 2020-08-27 |
| 1427661024 | Tanya Lee Wilson | Technician | 1968 Upper Little Birch Rd, Sutton, WV 26601-3781 | 2020-08-25 |
| 1053945980 | Kayla Denton | Doula | 901 Newville Rd, Sutton, WV 26601-6310 | 2020-02-29 |
| Find all providers in SUTTON | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619267937 | Chickaloon Native Villlage | Clinic/Center | 16166 North Glen Highway, Mile 61.5 Glen Highway, Sutton, AK 99674-1105 | 2011-04-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639652662 | Southcentral Foundation | Clinic/Center | 26341 Eklutna Village Rd, Chugiak, AK 99567-5148 | 2018-09-14 |
| 1881047108 | Aleutian Pribilof Islands Association | Clinic/Center | 111 Lakeview Rd., Nikolski, AK 99638 | 2016-07-21 |
| 1609232040 | Southcentral Foundation | Clinic/Center | 101 Indian Creek Road, Tyonek, AK 99682 | 2016-01-14 |
| 1235595562 | Chitina Traditional Indian Village Council | Clinic/Center | Mile 28.5 Edgerton Hwy, Chitina, AK 99566 | 2015-12-31 |
| 1770953903 | Southcentral Foundation | Clinic/Center | 1 Flight Line Rd, Port Alsworth, AK 99653-9801 | 2015-09-30 |
| 1144699216 | Southcentral Foundation | Clinic/Center | 4030 Salmon Way, Iguigig, AK 99613 | 2015-09-18 |
| 1295104644 | Southcentral Foundation | Clinic/Center | 102 Fireweed Lane, Newhalen, AK 99606 | 2015-09-16 |
| 1952770307 | Southcentral Foundation | Clinic/Center | 2516 Mountain Circle, Pedro Bay, AK 99647 | 2015-09-16 |
| 1205255957 | Front Street Health Center | Clinic/Center | 225 Front St Ste 202, Juneau, AK 99801-1244 | 2014-04-09 |
| 1851649305 | Alaska Island Community Services | Clinic/Center | 232 Wood St, Wrangell, AK 99929-1231 | 2012-08-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.