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General NPI Number Information
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NPI Number | 1104889252
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Entity Type | Organization
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Legal Business Name | JORDAN AND ASSOC HOME HEALTH
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 14618 LINCOLN AVE
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City | HARVEY
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State | IL
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Zip | 60426-1610
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Country | US
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Telephone | 708-331-8474
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Fax | 708-331-8648
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Provider Business Mailing Address
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Address Line | 14618 LINCOLN AVE
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City | HARVEY
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State | IL
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Zip | 60426-1610
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Country | US
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Telephone | 708-331-8474
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Fax | 708-331-8648
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JERRY DEAN JONES
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Credential | R.N.
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Telephone | 708-331-8474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 1010155
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License Number State | IL
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