SOUTHCENTRAL FOUNDATION (NPI# 1639102882) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1639102882 |
Entity Type | Organization |
Organization Name | SOUTHCENTRAL FOUNDATION |
Other Organization Name | THE PATHWAY HOME |
Practice Address |
4000 San Ernesto Ave Anchorage AK 99508-2874 |
Mailing Address |
4501 Diplomacy Dr Attn: Provider Enrollment Anchorage AK 99508-5919 |
Practice Telephone | 9077295020 |
Mailing Telephone | 9077294955 |
Enumeration Date | 2006-07-09 |
Last Update Date | 2016-01-28 |
Authorized Official Name | RONALD LEE OLSON (VP FINANCE) |
Authorized Official Telephone | 9077294939 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 320800000X | Community Based Residential Treatment Facility, Mental Illness | 20467 | AK | Residential Treatment Facilities |
Other Name | Type Code |
---|---|
The Pathway Home | 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 |
4000 SAN ERNESTO AVE |
City | ANCHORAGE |
State | AK |
Zip Code | 99508-2874 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528679388 | Jason Tholl | Behavior Technician | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2020-08-13 |
1972111045 | Alicia Rose Reando | Behavior Technician | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2020-07-15 |
1437770203 | Alicia Renee Washington | Psychologist | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2020-05-02 |
1760032486 | Hailey Rae Robertson | Behavior Technician | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2019-09-14 |
1083276968 | Gil Carr | Counselor | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2019-07-01 |
1902463292 | Shirley Dianne Ivie | Counselor | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2019-05-22 |
1225694003 | Laura Susan Southwell | Behavior Technician | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2019-05-16 |
1609432517 | Laura Elizabeth Nicolai | Counselor | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2019-05-15 |
1427614304 | Monique Jenae Singleton | Behavior Technician | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2019-05-15 |
1912563933 | Joel Edwin Schilling | Behavior Technician | 4000 San Ernesto Ave, Anchorage, AK 99508-2874 | 2019-05-15 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1366063349 | Alexandra L Davis | Student in an Organized Health Care Education/Training Program | 1202 E 36th Ave, Anchorage, AK 99508 | 2020-05-01 |
1366087108 | The Salvation Army, A California Corporation | Community/Behavioral Health | 3600 East 20th Avenue, Anchorage, AK 99508 | 2019-11-15 |
1679120349 | Kila Gilcart | Speech-Language Pathologist | 161 Klevin Street #103, Anchorage, AK 99508 | 2019-08-19 |
1326692963 | Shannon Maillet | Behavior Technician | 1650 S Bragaw, Anchorage, AK 99508 | 2019-07-31 |
1427602044 | Frank Harris Lawson Iv | Behavior Technician | 1650 S. Bragaw, Anchorage, AK 99508 | 2019-07-31 |
1104470723 | Vivalesi Seforosa Nair | Behavior Technician | 1650 South Bragaw, Anchorage, AK 99508 | 2019-07-31 |
1043864267 | The Cozy Chalet Assisted Living Home LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3707 Mt Blanc Circle, Anchorage, AK 99508 | 2019-07-25 |
1942861778 | Christine Mary Hoover | Registered Nurse | Alaska Native Medical Center - Inpatient Pediatrics, 4315 Diplomacy Dr, Anchorage, AK 99508 | 2019-06-24 |
1215594502 | Ashley Ongtowasruk | Case Manager/Care Coordinator | 4441 Dipomacy Dr, Suite 500, Anchorage, AK 99508 | 2019-05-22 |
1659937019 | Rayne Johnson | Behavior Technician | 4000 San Ernesto Blvd, Anchorage, AK 99508 | 2019-05-11 |
Find all providers in zip 99508 |
Taxonomy Code | 320800000X |
Grouping | Residential Treatment Facilities |
Classification | Community Based Residential Treatment Facility, Mental Illness |
A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |
Notes: [7/1/2003: new] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1114223476 | J.c Faith Open Arms #2 | Community Based Residential Treatment Facility, Mental Illness | 8301 E 11th Ct Unit 2, Anchorage, AK 99504-2210 | 2011-02-04 |
1790997922 | Helping Hands Alh Inc. | Community Based Residential Treatment Facility, Mental Illness | 1311 W 40th Ave, Anchorage, AK 99503-6507 | 2007-05-03 |
1700374550 | Sharon's Assisted Living, LLC | Community Based Residential Treatment Facility, Mental Illness | 1142 E 13th Ave, Anchorage, AK 99501-4739 | 2018-04-27 |
1184963225 | Peace and Harmony Alh | Community Based Residential Treatment Facility, Mental Illness | 107 Matthew Paul Way, Anchorage, AK 99504-4888 | 2013-02-09 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1477802197 | Aldergrove Assisted Living | Community Based Residential Treatment Facility, Mental Illness | 41045 Denny Lane, Homer, AK 99603 | 2012-09-10 |
1134408586 | Lynda Purvis | Community Based Residential Treatment Facility, Mental Illness | 117 1st Avenue, Fairbanks, AK 99701 | 2011-08-16 |
1467784140 | Tanana Chiefs Conference | Community Based Residential Treatment Facility, Mental Illness | 122 First Avenue 4th Floor, Fairbanks, AK 99701 | 2010-02-05 |
1154565133 | Tanana Chiefs Conference | Community Based Residential Treatment Facility, Mental Illness | 122 1st Ave Ste 4, Fairbanks, AK 99701-4871 | 2009-04-22 |
1689820979 | Akeela Inc | Community Based Residential Treatment Facility, Mental Illness | 3050 Fifth Ave, Ketchikan, AK 99901 | 2008-08-18 |
1255631446 | Boys and Girls Home of Alaska | Community Based Residential Treatment Facility, Mental Illness | 3101 Lathrop St, Fairbanks, AK 99701-7426 | 2010-10-22 |
1124350624 | Tanana Chiefs Conference | Community Based Residential Treatment Facility, Mental Illness | 122 1st Ave, Suite 400, Fairbanks, AK 99701 | 2010-02-08 |
1194969626 | Tanana Chiefs Conference | Community Based Residential Treatment Facility, Mental Illness | 122 1st Ave Ste 4, Fairbanks, AK 99701-4871 | 2009-04-28 |
1831332014 | Tanana Chiefs Conference | Community Based Residential Treatment Facility, Mental Illness | 122 1st Ave, 4th Fl, Fairbanks, AK 99701-4803 | 2009-04-17 |
1700086907 | Juneau Alliance for Mental Health, Inc | Community Based Residential Treatment Facility, Mental Illness | 3406 Glacier Hwy, Juneau, AK 99801-9501 | 2007-07-25 |
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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.