Provider Demographics
NPI:1184030520
Name:SU-VALLEY CARE COORDINATION, LLC
Entity Type:Organization
Organization Name:SU-VALLEY CARE COORDINATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCES
Authorized Official - Middle Name:D
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-841-2077
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:
Mailing Address - City:WILLOW
Mailing Address - State:AK
Mailing Address - Zip Code:99688-0513
Mailing Address - Country:US
Mailing Address - Phone:907-841-2077
Mailing Address - Fax:888-588-5194
Practice Address - Street 1:500 E SWANSON AVE STE 9
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7197
Practice Address - Country:US
Practice Address - Phone:907-841-2077
Practice Address - Fax:888-588-5194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK10018139251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management