| NPI | 1851921118 |
|---|---|
| Other Name | 1115 MH WAIVER |
| Doing Business As | SOUTHEAST PHYSICIAN SERVICES |
| Entity Type | Organization |
| Authorized Contact | JOSEPH WANNER Chief Financial Officer 907-796-8900 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2023-11-21 |