Healthcare Provider Details

I. General information

NPI: 1285069757
Provider Name (Legal Business Name): JORDAN MANAGEMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 HALSTEAD BLVD STE 5
ELIZABETH CITY NC
27909-6986
US

IV. Provider business mailing address

PO BOX 2213
ELIZABETH CITY NC
27906-2213
US

V. Phone/Fax

Practice location:
  • Phone: 252-334-1560
  • Fax: 252-334-1563
Mailing address:
  • Phone: 252-334-1560
  • Fax: 252-334-1563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNC
# 5
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code333300000X
TaxonomyEmergency Response System Companies
License Number
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateNC

VIII. Authorized Official

Name: MS. SANDRA S. JORDAN
Title or Position: SOLE MEMBER/CHIEF EXECUTIVE OFFICER
Credential: M.ED.
Phone: 252-334-1560