MEDICARE: FELICIA JORDAN

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	374U00000X	Home Health Aide	154274	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	154274	OTHER	OH	OHIO STATE INDEPENDENT PROVIDER

General Provider Information

NPI Number	:	1649642968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA JORDAN

Provider Business Mailing Address
First Line	:	2949 VAN AKEN BLVD
Second Line	:	APT.1
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-2279
Country	:	US
Telephone Number	:	216-556-3138
Fax Number	:

Provider Business Practice Location Address
First Line	:	2949 VAN AKEN BLVD
Second Line	:	APT.1
City	:	SHAKER HEIGHTS
State	:	OH
Zip	:	44120-2279
Country	:	US
Telephone Number	:	216-556-3138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2015
Last Update Date	:	10/26/2015

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Directions to “ FELICIA JORDAN ” Practice Location

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