Provider Demographics
NPI:1639382880
Name:C CARE SERVICES LLC
Entity Type:Organization
Organization Name:C CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATION ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:V
Authorized Official - Last Name:VIZCOCHO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:907-563-5002
Mailing Address - Street 1:7049 ARCTIC BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-2149
Mailing Address - Country:US
Mailing Address - Phone:907-560-5002
Mailing Address - Fax:907-563-5047
Practice Address - Street 1:7049 ARCTIC BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-2149
Practice Address - Country:US
Practice Address - Phone:907-560-5002
Practice Address - Fax:907-563-5047
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:C CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKCMG 911251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG 911Medicaid