Provider Demographics
NPI:1154833945
Name:JORDAN RIVER INC
Entity Type:Organization
Organization Name:JORDAN RIVER INC
Other - Org Name:GREEN LINE MEDICAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AIMAN
Authorized Official - Middle Name:ISMAIL
Authorized Official - Last Name:AWADALLAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-719-2853
Mailing Address - Street 1:4110 ST CHARLES BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2085
Mailing Address - Country:US
Mailing Address - Phone:210-719-2853
Mailing Address - Fax:
Practice Address - Street 1:4110 ST CHARLES BAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2085
Practice Address - Country:US
Practice Address - Phone:210-719-2853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker