Provider Demographics
NPI:1164715157
Name:THE JORDAN RIVER COMMUNITY DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:THE JORDAN RIVER COMMUNITY DEVELOPMENT CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:205-370-5288
Mailing Address - Street 1:444 ROSETA DR
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:AL
Mailing Address - Zip Code:35214-1938
Mailing Address - Country:US
Mailing Address - Phone:205-370-5288
Mailing Address - Fax:
Practice Address - Street 1:444 ROSETA DR
Practice Address - Street 2:
Practice Address - City:FORESTDALE
Practice Address - State:AL
Practice Address - Zip Code:35214-1938
Practice Address - Country:US
Practice Address - Phone:205-370-5288
Practice Address - Fax:205-637-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11020100320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities