Healthcare Provider Details

I. General information

NPI: 1053805663
Provider Name (Legal Business Name): JORDAN'S CROSSING HOME HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 PEACHTREE RD NE STE 555
ATLANTA GA
30326-1418
US

IV. Provider business mailing address

173 JANS MDWS
STOCKBRIDGE GA
30281-5855
US

V. Phone/Fax

Practice location:
  • Phone: 404-479-0619
  • Fax: 404-720-6726
Mailing address:
  • Phone: 404-479-0619
  • Fax: 404-720-6726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN130943
License Number StateGA

VIII. Authorized Official

Name: SABRINA MECHELE LEE
Title or Position: DIRECTOR OF NURSING/ADMINISTRATOR
Credential: RN
Phone: 404-988-0265