Provider Demographics
NPI:1750075107
Name:JORDAN, PATRICE
Entity type:Individual
Prefix:
First Name:PATRICE
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 1:4846 LEE RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3822
Mailing Address - Country:US
Mailing Address - Phone:440-503-0965
Mailing Address - Fax:
Practice Address - Street 1:4846 LEE RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-3822
Practice Address - Country:US
Practice Address - Phone:440-503-0965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-07
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH174200000X, 376J00000X, 385H00000X
372500000X, 385HR2060X, 374U00000X
OHSW766515172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No174200000XOther Service ProvidersMeals
No372500000XNursing Service Related ProvidersChore Provider
No172A00000XOther Service ProvidersDriver
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child