Provider Demographics
NPI:1285069757
Name:JORDAN MANAGEMENT GROUP, LLC
Entity type:Organization
Organization Name:JORDAN MANAGEMENT GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:252-334-1560
Mailing Address - Street 1:PO BOX 2213
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27906-2213
Mailing Address - Country:US
Mailing Address - Phone:252-334-1560
Mailing Address - Fax:252-334-1563
Practice Address - Street 1:905 HALSTEAD BLVD
Practice Address - Street 2:STE 5
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-6986
Practice Address - Country:US
Practice Address - Phone:252-334-1560
Practice Address - Fax:252-334-1563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251B00000X, 251J00000X, 251S00000X, 253Z00000X, 332U00000X, 333300000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251J00000XAgenciesNursing Care
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No332U00000XSuppliersHome Delivered Meals
No333300000XSuppliersEmergency Response System Companies
No385H00000XRespite Care FacilityRespite Care