Provider Demographics
NPI:1598758302
Name:JORDAN HOME HEALTH CARE, LLC
Entity Type:Organization
Organization Name:JORDAN HOME HEALTH CARE, LLC
Other - Org Name:JORDAN HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BLALOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-537-8621
Mailing Address - Street 1:1510 E GRANDE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3978
Mailing Address - Country:US
Mailing Address - Phone:903-577-8822
Mailing Address - Fax:903-577-0165
Practice Address - Street 1:1510 E GRANDE BLVD
Practice Address - Street 2:STE. C
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3978
Practice Address - Country:US
Practice Address - Phone:903-577-8822
Practice Address - Fax:903-577-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-26
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008180251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157246301Medicaid
TX157246302Medicaid
TX001004825Medicaid
TX158219902Medicaid
TX001004824Medicaid
TXHH205HOtherBCBS PROVIDER NUMBER
TX001004823Medicaid
TX677131Medicare Oscar/Certification