Healthcare Provider Details

I. General information

NPI: 1336331982
Provider Name (Legal Business Name): JORDAN'S CROSSING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W I 240 SERVICE RD
OKLAHOMA CITY OK
73139-7701
US

IV. Provider business mailing address

301 W I 240 SERVICE RD
OKLAHOMA CITY OK
73139-7701
US

V. Phone/Fax

Practice location:
  • Phone: 405-604-9644
  • Fax: 405-604-9689
Mailing address:
  • Phone: 405-604-9644
  • Fax: 405-604-9689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KAREN WALKER
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S., LPC, LMFT,LADC
Phone: 405-604-9644