Provider Demographics
NPI:1821769456
Name:SOUTHCENTRAL FOUNDATION
Entity Type:Organization
Organization Name:SOUTHCENTRAL FOUNDATION
Other - Org Name:SCF BSD ADULT OUTPATIENT SERVICES MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:CAYANONG
Authorized Official - Last Name:RANON-BACOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-729-6799
Mailing Address - Street 1:999 E TUDOR RD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-6123
Mailing Address - Country:US
Mailing Address - Phone:907-729-6799
Mailing Address - Fax:907-729-8607
Practice Address - Street 1:999 E TUDOR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-6123
Practice Address - Country:US
Practice Address - Phone:907-729-6799
Practice Address - Fax:907-729-8607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No251S00000XAgenciesCommunity/Behavioral Health