Jordan, Mike

Jordan, Mike is an sole proprietor health care provider with primary practice located at 2928 Withers Ave , Pueblo CO 81008-1248. He recently has only one registered license in Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as his primary health care specialty. Jordan, Mike can be contacted via phone (719) 543-8178.

Contact Information

Primary practice address
2928 Withers Ave Pueblo CO 81008-1248
Phone: (719) 543-8178
Fax: (719) 545-8583
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X

Profile Details

NPI number 1790153039
LBN Legal business name Jordan, Mike
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 3rd, 2015
Last updated Sep 3rd, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1790153039 NPPES
Colorado MEDICAID 47835346

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