Provider Demographics
NPI:1194460360
Name:JORDAN HOMECARE SERVICES
Entity Type:Organization
Organization Name:JORDAN HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:617-821-4923
Mailing Address - Street 1:2 BURLINGTON WOODS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4551
Mailing Address - Country:US
Mailing Address - Phone:617-821-4923
Mailing Address - Fax:617-675-7002
Practice Address - Street 1:1 HERBERT ST UNIT B
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3808
Practice Address - Country:US
Practice Address - Phone:617-821-4923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty