Provider Demographics
NPI:1740548791
Name:DISCOVERY CARE COORDINATION LLC
Entity type:Organization
Organization Name:DISCOVERY CARE COORDINATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-694-8585
Mailing Address - Street 1:17420 CHARITY LN
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7004
Mailing Address - Country:US
Mailing Address - Phone:907-694-8585
Mailing Address - Fax:907-694-2595
Practice Address - Street 1:17420 CHARITY LN
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7004
Practice Address - Country:US
Practice Address - Phone:907-694-8585
Practice Address - Fax:907-694-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMGXMedicaid