MIKE JORDAN NPI 1790153039

NPI Information

NPI: 1790153039
Provider Name: MIKE JORDAN
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Individual
Address:
2928 WITHERS AVE
PUEBLO, CO
ZIP 81008
Phone: (719) 543-8178
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Mike Jordan is a community based residential treatment facility, intellectual and/or developmental disabilities in Pueblo, CO. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. Mike Jordan NPI is 1790153039. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

2928 WITHERS AVE
PUEBLO, CO
ZIP 81008-248
Phone: (719) 543-8178
Fax: (719) 545-8583

The enumeration date for this NPI number is 9/3/2015 and was last updated on 9/3/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	47835346	MEDICAID	COLORADO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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