NPIMap

Organization Active NPI

Fountain Valley Health Care LLC

Doing business as Family Success Center

  • Primary Care Clinic/Center
  • Colorado Springs, CO
National Provider Identifier
1851170856
Registry record updated Sep 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
FOUNTAIN VALLEY HEALTH CARE LLC
Doing business as
Family Success Center
Practice address
1520 Verde Dr
Colorado Springs, CO 80910-1931
Phone
(719) 653-7776
NPI assigned
Sep 27, 2023
Last updated
Sep 27, 2023By 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 Sep 27, 2023

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) 653-7776

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Medicine (Family Medicine) Physician 207QA0401X NU
Primary Care Clinic/Center 261QP2300X NU Primary
Nurse Practitioner 363L00000X NU
Acute Care Nurse Practitioner 363LA2100X NU
Family Nurse Practitioner 363LF0000X NU

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 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.

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, 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": "1695772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695772800000",
    "number": "1851170856",
    "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": "2023-09-27",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "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": "719-653-7776",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "207QA0401X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Addiction Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Success Center",
            "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 Sep 27, 2023; 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.