Mike Jordan

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Practice address

2928 Withers Ave
Pueblo, CO 81008-1248

Phone

(719) 543-8178

Fax

(719) 545-8583

NPI assigned

Sep 3, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jordan Residential & Vocational Services Inc.

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Pueblo, CO
  • NPI 1124757745

  Community Based Residential Treatment Facility, Intellectual and/Or Developmental Disabilities

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441238400000",
    "number": "1790153039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8477",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810088477",
            "telephone_number": "719-543-8178",
            "fax_number": "719-545-8583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2928 WITHERS AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081248",
            "telephone_number": "719-543-8178",
            "fax_number": "719-545-8583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JORDAN",
        "first_name": "MIKE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-03",
        "last_updated": "2015-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47835346",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lucy Jones
• Michael Evan Jones, CRNA
• Scott Jones
• Jordan Residential & Vocational Services Inc.
• Jevin Jordan
• Joseph Gowen, O.D. and Associates, LLC
• Carol J. Joslin, MD
• David James Joyce, M.D.
• Lorraine Kay Jubic, RDH
• Ricco Nancy Julia, LCPC

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.