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 |