MEDICARE: JORDAN REHAB CORPORATION

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
1	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1194308510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN REHAB CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 26785
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-0785
Country	:	US
Telephone Number	:	267-254-2868
Fax Number	:

Provider Business Practice Location Address
First Line	:	7707 OGONTZ AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-1818
Country	:	US
Telephone Number	:	267-254-2868
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. KELTON JORDAN
Credential	:	DC
Telephone Number	:	267-254-2868

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	05/03/2021

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