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General NPI Number Information
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NPI Number | 1730574906
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Entity Type | Organization
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Legal Business Name | JORDICO LLC
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Dates
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Enumeration Date | 04/03/2015
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 4417 13TH STREET SUITE 142
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City | SAINT CLOUD
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State | FL
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Zip | 34769
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Country | US
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Telephone | 321-250-2496
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Fax |
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Provider Business Mailing Address
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Address Line | 4417 13TH ST SUITE 142
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City | SAINT CLOUD
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State | FL
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Zip | 34769-6724
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Country | US
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Telephone | 321-250-2496
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | KAYON JONES
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Credential |
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Telephone | 321-250-2496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number | L15000044009
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License Number State | FL
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