Provider Demographics
NPI:1366706061
Name:JOAN'S COMPLETE CARE
Entity type:Organization
Organization Name:JOAN'S COMPLETE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:HEIKENS
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:907-835-4326
Mailing Address - Street 1:BOX 3335
Mailing Address - Street 2:5510 WILDERNESS CT.
Mailing Address - City:VALDEZ
Mailing Address - State:AK
Mailing Address - Zip Code:99686
Mailing Address - Country:US
Mailing Address - Phone:907-835-4326
Mailing Address - Fax:907-835-4326
Practice Address - Street 1:5510 WILDERNESS CT.
Practice Address - Street 2:
Practice Address - City:VALDEZ
Practice Address - State:AK
Practice Address - Zip Code:99686
Practice Address - Country:US
Practice Address - Phone:907-835-4326
Practice Address - Fax:907-835-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-27
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK958238251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management