NPIMap

Organization Active NPI

Fountain Valley Health Care LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Colorado Springs, CO
National Provider Identifier
1043074024
Registry record updated Feb 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
FOUNTAIN VALLEY HEALTH CARE LLC
Practice address
1520 Verde Dr
Colorado Springs, CO 80910-1931
Phone
(719) 653-7776
NPI assigned
Feb 9, 2024
Organization subpart
Yes
Parent organization
FOUNTAIN VALLEY HEALTH CARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 9, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jacquita Louise Jordan, DNPNPI 1730558834
Title
Owner
Phone
(719) 358-7338

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X
Psychiatric/Mental Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LP0808X Primary

Addresses

Primary practice location

1520 Verde Dr
Colorado Springs, CO 80910-1931

Mailing address

1259 Lake Plaza Dr Ste 270
Colorado Springs, CO 80906-3560

Other names 1

  • Family Success Center Behavioral Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Fountain Valley Health Care LLC4 organizations share this tax ID, including this one
Part of
Fountain Valley Health Care LLC

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1520 Verde Dr
Colorado Springs, CO 80910
Phone (719) 493-9555

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707436800000",
    "number": "1043074024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1259 LAKE PLAZA DR STE 270",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1520 VERDE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809101931",
            "telephone_number": "719-653-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNTAIN VALLEY HEALTH CARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOUNTAIN VALLEY HEALTH CARE LLC",
        "enumeration_date": "2024-02-09",
        "last_updated": "2024-02-09",
        "certification_date": "2024-02-09",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "JACQUITA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-358-7338",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Success Center Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.