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General NPI Number Information
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NPI Number | 1275115297
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Entity Type | Individual
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Provider Name | JOAN RICHARDS GORDON
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Gender | Female
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Dates
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Enumeration Date | 04/28/2021
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Last Update Date | 04/28/2021
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Provider Practice Location Address
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Address Line | 157 159 LEXINGTON AVENUE
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City | DAYTON
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State | OH
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Zip | 45402
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Country | US
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Telephone | 443-845-1961
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Fax |
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Provider Business Mailing Address
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Address Line | 12908 CROSSFIELD DR
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City | BELTSVILLE
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State | MD
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Zip | 20705-6334
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Country | US
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Telephone | 443-845-1961
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376G00000X
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Taxonomy Name | Nursing Home Administrator
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License Number |
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License Number State |
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