Provider Demographics
NPI:1497414759
Name:RIVER JORDAN, INC.
Entity type:Organization
Organization Name:RIVER JORDAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALAND
Authorized Official - Middle Name:
Authorized Official - Last Name:STAMPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-671-7431
Mailing Address - Street 1:3442 KIESEL RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-2446
Mailing Address - Country:US
Mailing Address - Phone:989-671-7431
Mailing Address - Fax:
Practice Address - Street 1:3442 KIESEL RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-2446
Practice Address - Country:US
Practice Address - Phone:989-671-7431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIS351040139364OtherDRIVERS LICENSE