Healthcare Provider Details

I. General information

NPI: 1124416417
Provider Name (Legal Business Name): JORDAN YOUNG INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 CLEVELAND ST
VIRGINIA BEACH VA
23462-1784
US

IV. Provider business mailing address

5716 CLEVELAND ST
VIRGINIA BEACH VA
23462-1784
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-4802
  • Fax: 757-961-9767
Mailing address:
  • Phone: 757-490-4802
  • Fax: 757-961-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: LORI DELBRIDGE
Title or Position: ADMINISTRATOR
Credential:
Phone: 757-502-8570