Provider Demographics
NPI:1457940819
Name:JORDAN, ANTHONY SR (PERSONAL CHEF)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:
Last Name:JORDAN
Suffix:SR
Gender:M
Credentials:PERSONAL CHEF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4657 KIRBY AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45223-1521
Mailing Address - Country:US
Mailing Address - Phone:513-746-8233
Mailing Address - Fax:
Practice Address - Street 1:4657 KIRBY AVE APT 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45223-1521
Practice Address - Country:US
Practice Address - Phone:513-746-8233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRC420468174200000X
174200000X
OH332U00000X, 174200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174200000XOther Service ProvidersMeals
No332U00000XSuppliersHome Delivered Meals