NPIMap

Organization Active NPI

Fountain Valley Health Care LLC

Doing business as Fountain Valley Behavioral Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Fountain, CO
National Provider Identifier
1225890619
Registry record updated Jun 26, 2026
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
Doing business as
Fountain Valley Behavioral Health
Practice address
5115 Fontaine Blvd
Fountain, CO 80817-1061
Phone
(719) 653-7776
NPI assigned
Jan 30, 2024
Last updated
Jun 26, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
FOUNTAIN VALLEY HEALTH CARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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
Psychiatric/Mental Health Nurse Practitioner 363LP0808X Primary
Counselor 101Y00000X

Addresses

Primary practice location

5115 Fontaine Blvd
Fountain, CO 80817-1061

Mailing address

10265 Rolling Ridge Rd
Colorado Springs, CO 80925-9509
Phone (719) 653-7776

Other identifiers 1

IdentifierTypeStateIssuer
9000226000MedicaidCO

Other names 1

  • Fountain Valley Behavioral Health Doing business as

National Provider Directory

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

Other organizations with this tax ID 3

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

Locations

5115 Fontaine Blvd
Fountain, CO 80817
Phone (719) 392-2000

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 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782432000000",
    "number": "1225890619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10265 ROLLING RIDGE RD",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809259509",
            "telephone_number": "719-653-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5115 FONTAINE BLVD",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808171061",
            "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": "2024-01-30",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "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": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000226000",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fountain Valley Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fountain Valley Behavioral Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fountain, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2026; 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.