Provider Demographics
NPI:1497423834
Name:JORDAN, RASHANDA
Entity Type:Individual
Prefix:MRS
First Name:RASHANDA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RASHANDA
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 E PHILADELPHIA ST # SY
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-2227
Mailing Address - Country:US
Mailing Address - Phone:313-818-9208
Mailing Address - Fax:
Practice Address - Street 1:62 E PHILADELPHIA ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-2227
Practice Address - Country:US
Practice Address - Phone:313-818-9208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty