Provider Demographics
NPI:1689826968
Name:JV CARE COORDINATION
Entity Type:Organization
Organization Name:JV CARE COORDINATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROGRAM ADMINISTRATOR
Authorized Official - Prefix:
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:907-336-1820
Mailing Address - Street 1:1812 TERREBONNE LOOP
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-7271
Mailing Address - Country:US
Mailing Address - Phone:907-336-1820
Mailing Address - Fax:907-336-1931
Practice Address - Street 1:1812 TERREBONNE LOOP
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-7271
Practice Address - Country:US
Practice Address - Phone:907-336-1820
Practice Address - Fax:907-336-1931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK746422171M00000X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCM 16581Medicaid
AKCMG 165Medicaid