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NPI Code Detail

MEDICARE: GEORGE JORDAN III

MEDICARE: GEORGE JORDAN III
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1322D00000XEmotionally Disturbed Childrens' Residential Treatment FacilityNPPESCA

General Provider Information

NPI Number : 1770292831
Entity Type Code : Individual
Provider Name (Legal Business Name) : GEORGE JORDAN III
Provider Business Mailing Address
First Line : 4892 SAN PABLO DAM RD
Second Line :
City : EL SOBRANTE
State : CA
Zip : 94803-3222
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4892 SAN PABLO DAM RD
Second Line :
City : EL SOBRANTE
State : CA
Zip : 94803-3222
Country : US
Telephone Number : 510-223-4236
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2022
Last Update Date : 12/18/2025

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Directions to “ GEORGE JORDAN III ” Practice Location

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