Provider Demographics
NPI:1992441240
Name:BUCKEYE CARE COORDINATION, LLC
Entity type:Organization
Organization Name:BUCKEYE CARE COORDINATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM MANAGER/CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MOSSHOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-414-6268
Mailing Address - Street 1:2521 E MOUNTAIN VILLAGE DR STE B
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7332
Mailing Address - Country:US
Mailing Address - Phone:907-414-6268
Mailing Address - Fax:907-782-4268
Practice Address - Street 1:1635 E KINZI CIR APT 2
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-8378
Practice Address - Country:US
Practice Address - Phone:907-414-6268
Practice Address - Fax:907-782-4268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management