Provider Demographics
NPI:1396519955
Name:JORDAN HGH LLC
Entity type:Organization
Organization Name:JORDAN HGH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:ROBERTA
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-475-6732
Mailing Address - Street 1:806 GREEN VALLEY RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7076
Mailing Address - Country:US
Mailing Address - Phone:888-475-6732
Mailing Address - Fax:
Practice Address - Street 1:806 GREEN VALLEY RD STE 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7076
Practice Address - Country:US
Practice Address - Phone:888-475-6732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health