Provider Demographics
NPI:1467677880
Name:VALLEY CARE COORDINATION
Entity Type:Organization
Organization Name:VALLEY CARE COORDINATION
Other - Org Name:DESIREE ORTEGA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-357-8028
Mailing Address - Street 1:3275 PINTAIL CIR
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-2617
Mailing Address - Country:US
Mailing Address - Phone:907-357-8028
Mailing Address - Fax:907-357-8028
Practice Address - Street 1:3275 PINTAIL CIR
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-2617
Practice Address - Country:US
Practice Address - Phone:907-357-8028
Practice Address - Fax:907-357-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCMG149251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG149Medicaid
AKCM#14941Medicaid