JORDAN MICHAEL SULLIVAN NPI 1083199434

NPI Information

  • NPI: 1083199434
  • Provider Name: JORDAN MICHAEL SULLIVAN
  • Classification: Day Training/Habilitation Specialist - 373H00000X
  • Entity Type: Individual
  • Address: 1520 EUREKA RD STE 102
    ROSEVILLE, CA
    ZIP 95661
  • Phone: (916) 759-1168

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NPI Details

Jordan Michael Sullivan is a day training habilitation specialist in Roseville, CA. The provider is individuals experienced or trained in working with developmentally disabled individuals who need assistance in acquiring and maintaining life skills that enable them to cope more effectively with the demands of independent living. Jordan Michael Sullivan NPI is 1083199434. 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:

1520 EUREKA RD STE 102
ROSEVILLE, CA
ZIP 95661-849
Phone: (916) 759-1168

The enumeration date for this NPI number is 10/2/2018 and was last updated on 4/23/2025.

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
1101Y00000XCounselorNo
2101YM0800XCounselorMental HealthNo
3106S00000XBehavior TechnicianNo
4171M00000XCase Manager/Care CoordinatorNo
5172V00000XCommunity Health WorkerNo
6225400000XRehabilitation PractitionerNo
7373H00000XDay Training/Habilitation SpecialistYes

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: 11/21/2025

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