Provider Demographics
NPI:1225117419
Name:JORDAN & GILLIS INC
Entity Type:Organization
Organization Name:JORDAN & GILLIS INC
Other - Org Name:THE HERITAGE NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLEN
Authorized Official - Suffix:
Authorized Official - Credentials:LNFA
Authorized Official - Phone:903-763-2284
Mailing Address - Street 1:1026 E GOODE ST
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75783-1641
Mailing Address - Country:US
Mailing Address - Phone:903-763-2284
Mailing Address - Fax:903-763-4301
Practice Address - Street 1:1026 E GOODE ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:TX
Practice Address - Zip Code:75783-1641
Practice Address - Country:US
Practice Address - Phone:903-763-2284
Practice Address - Fax:903-763-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000410803314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4108Medicaid
TX4108Medicaid