Mike Jordan
Mike Jordan is an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Pueblo, Colorado. Practices as a sole proprietor. Registered with an NPI since 2015.
- In the registry since
- 2015
Practice location Address checks out
2928 Withers AvePueblo, CO 81008-1248
Phone: (719) 543-8178
Fax: (719) 545-8583
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Specialties & licences
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) | Taxonomy 320900000X |
|---|
Record details
| NPI number | 1790153039 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | September 3, 2015 |
| Last updated in NPPES | September 3, 2015 |
| Mailing address | Po Box 8477, Pueblo, CO 81008-8477 |
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