Provider Demographics
NPI:1124416417
Name:JORDAN YOUNG INSTITUTE
Entity Type:Organization
Organization Name:JORDAN YOUNG INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:DELBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-502-8570
Mailing Address - Street 1:5716 CLEVELAND ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1784
Mailing Address - Country:US
Mailing Address - Phone:757-490-4802
Mailing Address - Fax:757-961-9767
Practice Address - Street 1:5716 CLEVELAND ST
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-1784
Practice Address - Country:US
Practice Address - Phone:757-490-4802
Practice Address - Fax:757-961-9767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-08
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
No246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic AssistantGroup - Single Specialty