Provider Demographics
NPI:1306545348
Name:JORDAN, GLORIA J
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:J
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 1:2313 LEE RD STE 414
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:216-278-7058
Practice Address - Street 1:571 E 107TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-1431
Practice Address - Country:US
Practice Address - Phone:440-554-2156
Practice Address - Fax:216-278-7058
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH347C00000X, 372600000X, 3747P1801X, 376J00000X, 385HR2060X, 3747P1801X
3747P1801X, 385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1832266OtherDODD CONTRACT NUMBER
OH0500585Medicaid