MEDICARE: JORDAN HOME HEALTH CARE, LLC

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	251E00000X	Home Health Agency	008181	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HH9164	OTHER	TX	BCBS PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922091651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN HOME HEALTH CARE, LLC

Provider Business Mailing Address
First Line	:	3010 LYNDON B JOHNSON FWY STE 1100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-2712
Country	:	US
Telephone Number	:	800-379-1600
Fax Number	:	903-537-8420

Provider Business Practice Location Address
First Line	:	3505 SUMMERHILL RD STE 8
Second Line	:
City	:	TEXARKANA
State	:	TX
Zip	:	75503-3596
Country	:	US
Telephone Number	:	903-794-3102
Fax Number	:	903-793-1875

Authorized Official
Title or Position	:	COMPLIANCE PRIVACY&SAFETY OFFICER
Name	:	KATIE MONASTIERE
Credential	:
Telephone Number	:	517-768-4373

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	09/30/2024

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