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Organization
FOUNTAIN VALLEY HEALTH CARE LLC
Active
Organization
FOUNTAIN VALLEY HEALTH CARE LLC
Active
Parent organization
FOUNTAIN VALLEY HEALTH CARE LLC
Other names
Family Success Center Behavioral Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
FOUNTAIN VALLEY HEALTH CARE LLC
Authorized official
JACQUITA LOUISE JORDAN DNP (OWNER)
(719) 358-7338
Entity
Organization
Contact information
Practice address
1520 VERDE DR, COLORADO SPRINGS, CO 80910-1931
(719) 653-7776
Mailing address
1259 LAKE PLAZA DR STE 270, COLORADO SPRINGS, CO 80906-3560
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
02/09/2024
Last updated
02/09/2024
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