Healthcare Provider Details

I. General information

NPI: 1962275511
Provider Name (Legal Business Name): JORDAN HGH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2023
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5106 OLDE FOREST DR
GREENSBORO NC
27406-8718
US

IV. Provider business mailing address

806 GREEN VALLEY RD STE 200
GREENSBORO NC
27408-7076
US

V. Phone/Fax

Practice location:
  • Phone: 919-914-1287
  • Fax:
Mailing address:
  • Phone: 888-475-6732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MELISSA ROBERTA JORDAN
Title or Position: CEO
Credential: LPN
Phone: 919-914-1287