Provider Demographics
NPI:1215913801
Name:SOUTH EAST ALASKA REGIONAL HEALTH CONSORTIUM
Entity type:Organization
Organization Name:SOUTH EAST ALASKA REGIONAL HEALTH CONSORTIUM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-463-4000
Mailing Address - Street 1:3100 CHANNEL DRIVE
Mailing Address - Street 2:STE 300
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-463-4074
Mailing Address - Fax:907-463-1510
Practice Address - Street 1:7300 KLAWOCK-HOLLIS HWY
Practice Address - Street 2:
Practice Address - City:KLAWOCK
Practice Address - State:AK
Practice Address - Zip Code:99925-0069
Practice Address - Country:US
Practice Address - Phone:907-755-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-16
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
AK70206261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG632Medicaid
AKCL2276Medicaid
AKDDG225Medicaid
AKMDG631Medicaid
AKPH0025Medicare ID - Type UnspecifiedPHARMACY NUMBER
AKMDG632Medicaid
AKTEZ066Medicare ID - Type UnspecifiedPART B