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NPI Code Detail

MEDICARE: JORDYAN PHOENIX

MEDICARE: JORDYAN PHOENIX
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant

General Provider Information

NPI Number : 1023966728
Entity Type Code : Individual
Provider Name (Legal Business Name) : JORDYAN PHOENIX
Provider Business Mailing Address
First Line : 1005 TERMINAL WAY STE 125
Second Line :
City : RENO
State : NV
Zip : 89502-2198
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1005 TERMINAL WAY STE 125
Second Line :
City : RENO
State : NV
Zip : 89502-2198
Country : US
Telephone Number : 775-786-4999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/18/2026
Last Update Date : 03/18/2026

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Directions to “ JORDYAN PHOENIX ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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