Provider Demographics
NPI:1821154659
Name:JORDON ENTERPRISES, INC.
Entity Type:Organization
Organization Name:JORDON ENTERPRISES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDON
Authorized Official - Suffix:
Authorized Official - Credentials:RRT, RCP
Authorized Official - Phone:336-315-5394
Mailing Address - Street 1:PO BOX 7100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27417-0100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 FAIRFAX RD
Practice Address - Street 2:SUITE 117
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3009
Practice Address - Country:US
Practice Address - Phone:336-315-5394
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00593332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7701562Medicaid
NC7701562Medicaid