Organization
JV CARE COORDINATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSE V VIZCOCHO M.A. (OWNER/PROGRAM ADMINISTRATOR)
(907) 336-1820
Entity
Organization
Contact information
Practice address
1812 TERREBONNE LOOP, ANCHORAGE, AK 99502-7271
(907) 336-1820
(907) 336-1931
Mailing address
1812 TERREBONNE LOOP, ANCHORAGE, AK 99502-7271
(907) 336-1820
(907) 336-1931
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
746422
AK
251B00000X
Case Management Agency
Primary
746422
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CM 16581
—
AK
05
—
CMG 165
—
AK
Enumeration date
10/17/2008
Last updated
10/17/2008
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