1467677880 NPI number — VALLEY CARE COORDINATION

Table of content: MRS. ALEXANDRA ANNE JURENKO LCSW (NPI 1922245950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467677880 NPI number — VALLEY CARE COORDINATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY CARE COORDINATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467677880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3275 PINTAIL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASILLA
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99654-2617
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-357-8028
Provider Business Mailing Address Fax Number:
907-357-8028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3275 PINTAIL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASILLA
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99654-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-357-8028
Provider Business Practice Location Address Fax Number:
907-357-8028
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ORTEGA
Authorized Official First Name:
DESIREE
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM ADMINISTRATOR
Authorized Official Telephone Number:
907-357-8028

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  CMG149 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CMG149 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM#14941 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




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