Mike Jordan

NPI #1790153039 in Pueblo, Colorado

Provider Information

NPI Number: 1790153039
Entity Type: Individual
Name: Mike Jordan
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Sep 3, 2015
Last Updated: Sep 3, 2015

Practice Location

Address: 2928 WITHERS AVE
City: Pueblo
State: Colorado
ZIP Code: 81008-1248
Phone: (719) 543-8178

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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Organizations

Provider Name	Specialty	City
Pueblo Regional Center	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	Pueblo	AI Deep Dive
Pueblo Regional Center	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	Pueblo	AI Deep Dive

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