Provider Demographics
NPI:1164721254
Name:STEPHANIE JORDAN MINISTRIES, INC.
Entity Type:Organization
Organization Name:STEPHANIE JORDAN MINISTRIES, INC.
Other - Org Name:TEMPLE SMOOTHIES AND CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ROZELL
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:219-331-3046
Mailing Address - Street 1:P.O. BOX 76
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46361-0076
Mailing Address - Country:US
Mailing Address - Phone:219-331-3046
Mailing Address - Fax:
Practice Address - Street 1:1904 E. US HWY 20
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360
Practice Address - Country:US
Practice Address - Phone:219-331-3046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28146885A164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Single Specialty