Provider Demographics
NPI:1114515384
Name:JORDAN RIVER HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:JORDAN RIVER HOME HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-397-8610
Mailing Address - Street 1:501 GOODLETTE RD STE D-25
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5661
Mailing Address - Country:US
Mailing Address - Phone:786-397-8610
Mailing Address - Fax:239-331-2626
Practice Address - Street 1:501 GOODLETTE RD STE D-25
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5661
Practice Address - Country:US
Practice Address - Phone:786-397-8610
Practice Address - Fax:239-331-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-04
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health