Provider Demographics
NPI:1952447104
Name:JORDAN HEALTH SERVICES PAS SHERMAN
Entity Type:Organization
Organization Name:JORDAN HEALTH SERVICES PAS SHERMAN
Other - Org Name:ELARA CARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-870-7874
Mailing Address - Street 1:220 SUNSET BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7465
Mailing Address - Country:US
Mailing Address - Phone:903-870-7874
Mailing Address - Fax:903-870-7875
Practice Address - Street 1:220 SUNSET BLVD STE D
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7465
Practice Address - Country:US
Practice Address - Phone:903-870-7874
Practice Address - Fax:903-870-7875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX008270251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX000031900Medicaid
TX945165168OtherTDHCONNECT - PHC
TX245196161OtherANSI EDI - PHC