Provider Demographics
NPI:1366866758
Name:JORDAN, ROSIE ANN (ADMINISTRATOR)
Entity Type:Individual
Prefix:MRS
First Name:ROSIE
Middle Name:ANN
Last Name:JORDAN
Suffix:
Gender:F
Credentials:ADMINISTRATOR
Other - Prefix:MRS
Other - First Name:ROSIE
Other - Middle Name:ANN
Other - Last Name:JORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ADMINISTRATOR
Mailing Address - Street 1:611 REDBUD ST
Mailing Address - Street 2:611 REDBUD ST
Mailing Address - City:HENDERSON
Mailing Address - State:TX
Mailing Address - Zip Code:75652-6543
Mailing Address - Country:US
Mailing Address - Phone:903-646-6291
Mailing Address - Fax:
Practice Address - Street 1:611 REDBUD ST
Practice Address - Street 2:611 REDBUD ST
Practice Address - City:HENDERSON
Practice Address - State:TX
Practice Address - Zip Code:75652-6543
Practice Address - Country:US
Practice Address - Phone:903-646-6291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0218196500Medicaid
TX0218196500Medicaid