MIKE JORDAN (NPI# 1790153039) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790153039 |
| Entity Type | Individual |
| Full Name | MIKE JORDAN |
| Practice Address |
2928 Withers Ave Pueblo CO 81008-1248 |
| Mailing Address |
Po Box 8477 Pueblo CO 81008-8477 |
| Practice Telephone | 7195438178 |
| Practice Fax Number | 7195458583 |
| Mailing Telephone | 7195438178 |
| Mailing Fax Number | 7195458583 |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2015-09-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | 47835346 | 05 |
| Street Address |
2928 WITHERS AVE |
| City | PUEBLO |
| State | CO |
| Zip Code | 81008-1248 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164058913 | Healthone Clinic Services - Oncology Hematology LLC | Internal Medicine | 3678 Parker Blvd, Pueblo, CO 81008 | 2020-03-12 |
| 1073026423 | Carmel Community Living Corporation | Respite Care | 2003 Northmoor Terrace, Suite 100, Pueblo, CO 81008 | 2017-11-08 |
| 1568987121 | Hannah Vivian Roadruck | Pharmacist | 4200 Dillon Dr., Pueblo, CO 81008 | 2017-08-04 |
| 1184170425 | Brett Burana | Dentist | 729 Us-50, Pueblo, CO 81008 | 2016-08-28 |
| 1760832885 | Irby Dental Cottage | Dental Hygienist | 2099 West St # 50, Suite 180, Pueblo, CO 81008 | 2016-06-20 |
| 1649624362 | Curley Peak Dentistry Pllc | Dentist | 1640 W Fortino Blvd, Pueblo, CO 81008 | 2016-04-19 |
| 1336507847 | Kyle Tipton | Nurse Anesthetist, Certified Registered | 4741 Eagleridge Circle, 206, Pueblo, CO 81008 | 2016-01-29 |
| 1407211931 | Center At Park West, LLC | Skilled Nursing Facility | 3727 Parker Blvd., Pueblo, CO 81008 | 2015-12-29 |
| 1417327461 | Nicole Betts | Registered Nurse | 1310 Fortino Blvd Ste D, Pueblo, CO 81008 | 2015-10-02 |
| 1437578028 | Pueblo Modern Dentistry and Orthodontics, LLP | Dentist | 727 Us Hwy 50 West, Pueblo, CO 81008 | 2014-04-10 |
| Find all providers in zip 81008 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053850297 | Sparks Residential and Support Services, Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1762 27th Ln, Pueblo, CO 81006-9702 | 2017-02-21 |
| 1710426234 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 416 E Maher Dr, Pueblo, CO 81007-3514 | 2017-02-16 |
| 1043759558 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 198 E Galatea Dr, Pueblo, CO 81007-2730 | 2017-02-16 |
| 1760921274 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 268 W Harmony Dr, Pueblo, CO 81007-6379 | 2017-02-16 |
| 1912446436 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 272 W Harmony Dr, Pueblo, CO 81007-6379 | 2017-02-16 |
| 1255870754 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 496 S Latimer Dr, Pueblo, CO 81007-3521 | 2017-02-16 |
| 1043759541 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 614 S Clarion Dr, Pueblo, CO 81007-1524 | 2017-02-16 |
| 1518406016 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 262 S Bayfield Ave, Pueblo, CO 81007-2750 | 2017-02-16 |
| 1538608039 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 887 S Bellflower Dr, Pueblo, CO 81007-1902 | 2017-02-16 |
| 1689113193 | Pueblo Regional Center | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 330 E Hahns Peak Ave, Pueblo, CO 81007-2793 | 2017-02-16 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.