MIKE JORDAN
NPI 1790153039
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Pueblo, CO

Q: What is Mike Jordan's NPI number?

The NPI number for Mike Jordan is 1790153039. It was assigned to this individual provider in the NPPES registry on September 3, 2015.

Q: What is Mike Jordan's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Q: When was this NPI record last updated?

The NPPES record for Mike Jordan was last updated on September 3, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 03, 2015

2928 WITHERS AVE, PUEBLO, CO 81008(719) 543-8178(719) 545-8583 Get Directions Write a Review

NPPES record last updated: September 3, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Mike Jordan NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIKE JORDAN (NPI 1790153039) is an individual community based residential treatment facility, intellectual and/or developmental disabilities provider in Pueblo, Colorado and active in the NPI registry since September 2015.

NPPES Registry Identity

NPI1790153039

Entity TypeIndividualMale

Primary Taxonomy320900000X

Provider Legal NameMIKE JORDAN

Location Address2928 WITHERS AVEPueblo, CO 81008-1248

Mailing AddressPo Box 8477Pueblo, CO 81008-8477 · (719) 543-8178 · Fax (719) 545-8583

Phone(719) 543-8178

Fax(719) 545-8583

Sole ProprietorYes

Enumeration DateSeptember 3, 2015

✔ NPI 1790153039 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities

Taxonomy Code320900000X

Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

2928 WITHERS AVE, Pueblo, CO 81008

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Other Identifiers 1

Medicaid47835346CO

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JORDAN RESIDENTIAL & VOCATIONAL SERVICES INC.

Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities

2928 WITHERS AVE
PUEBLO, CO 81008

Pueblo County (719) 543-8178

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mike Jordan's NPI number?

The NPI number for Mike Jordan is 1790153039. It was assigned to this individual provider in the NPPES registry on September 3, 2015.

Where is Mike Jordan located?

Mike Jordan practices at 2928 Withers Ave, Pueblo, CO 81008. The listed phone number is (719) 543-8178.

What is Mike Jordan's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

When was this NPI record last updated?

The NPPES record for Mike Jordan was last updated on September 3, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.