| Jordanica Inc | |
|
780 Coronado Center Dr Suite 110a Henderson NV 89052-5040 | |
| (702) 358-0464 | |
| (610) 432-3508 |
| Full Name | Jordanica Inc |
|---|---|
| Speciality | Social Worker |
| Location | 780 Coronado Center Dr, Henderson, Nevada |
| Authorized Official Name and Position | Mark A. Premselaar (PRESIDENT) |
| Authorized Official Contact | 7023580464 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jordanica Inc 780 Coronado Center Dr Suite 110a Henderson NV 89052-5040 Ph: (702) 358-0464 | Jordanica Inc 780 Coronado Center Dr Suite 110a Henderson NV 89052-5040 Ph: (702) 358-0464 |
| NPI Number | 1043515570 |
|---|---|
| Provider Enumeration Date | 01/13/2011 |
| Last Update Date | 01/13/2011 |
| Medicare PECOS PAC ID | 7517148125 |
|---|---|
| Medicare Enrollment ID | O20110301000955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043515570 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 5782C (Nevada) | Primary |
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