person
Mike Jordan
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Pueblo, Colorado
NPI 1790153039

Mike Jordan is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Pueblo, CO. Mike Jordan practices in Pueblo, CO. The NPI Number for Mike Jordan is 1790153039 and holds a License No. (Colorado).

The current practice location address for Mike Jordan is 2928 Withers Ave, Pueblo, CO and can be reached out via phone at 719-543-8178 and via fax at 719-545-8583. You can also correspond with Mike Jordan through the mailing address at PO BOX 8477, PUEBLO, CO - 81008-8477 (mailing address contact number: 719-543-8178).

Location: 2928 Withers Ave, Pueblo, CO, 81008-8477
person
Provider Profile Details
NPI Number
1790153039
Provider Name
Mike Jordan
Credential
Provider Entity Type
Individual
Gender
Male
Address
2928 Withers Ave, Pueblo, CO, 81008-8477
Phone Number
719-543-8178
Fax Number
719-545-8583
Provider Enumeration Date
09/03/2015
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
47835346 05 CO
institution
Provider Business Practice Location Address Details
Address
2928 Withers Ave
City
State
Zip
81008-1248
Phone Number
719-543-8178
Fax Number
719-545-8583
person
Provider Business Mailing Address Details
Address
2928 Withers Ave
City
State
Zip
81008-1248
Phone Number
719-543-8178
Fax Number
719-545-8583
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
License No.
()
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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