Provider Demographics
NPI:1790004521
Name:JORDAN COMPASSINATE HOME CARE
Entity Type:Organization
Organization Name:JORDAN COMPASSINATE HOME CARE
Other - Org Name:HOMECLINICHEATLHCAREPHSYICAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENTAND FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAYMONDA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-523-3187
Mailing Address - Street 1:20080 WESTPHALIA ST
Mailing Address - Street 2:7
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48205-1149
Mailing Address - Country:US
Mailing Address - Phone:313-523-3187
Mailing Address - Fax:
Practice Address - Street 1:20080 WESTPHALIA ST
Practice Address - Street 2:7
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48205-1149
Practice Address - Country:US
Practice Address - Phone:313-523-3187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-18
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MID3855Y251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health