Healthcare Provider Details

I. General information

NPI: 1013921014
Provider Name (Legal Business Name): JORDAN'S NURSING HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9935 RED ARROW HWY
BRIDGMAN MI
49106-0607
US

IV. Provider business mailing address

9935 RED ARROW HWY
BRIDGMAN MI
49106-0607
US

V. Phone/Fax

Practice location:
  • Phone: 269-465-3017
  • Fax: 269-465-0327
Mailing address:
  • Phone: 269-465-3017
  • Fax: 269-465-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number114170
License Number StateMI

VIII. Authorized Official

Name: MR. RANDY JORDAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 269-465-3017