Provider Demographics
NPI:1700630233
Name:JORDAN, ERICA
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 VERSAILLES APT W
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3837
Mailing Address - Country:US
Mailing Address - Phone:513-952-3249
Mailing Address - Fax:
Practice Address - Street 1:45 VERSAILLES APT W
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-3837
Practice Address - Country:US
Practice Address - Phone:513-952-3249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-12
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 372600000X, 376J00000X, 374U00000X
OHSK206881172A00000X
OH253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No251E00000XAgenciesHome Health
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker