1376788182 NPI number — SILVER CREEK FORENSIC AND CLINICAL

Table of content: MR. ALAN RICHARD JORDAN MSW,LICSW (NPI 1720008352)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376788182 NPI number — SILVER CREEK FORENSIC AND CLINICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SILVER CREEK FORENSIC AND CLINICAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376788182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2770 E FRANKLIN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83642-5953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-855-0660
Provider Business Mailing Address Fax Number:
208-898-9433

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2770 E FRANKLIN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-5953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-855-0660
Provider Business Practice Location Address Fax Number:
208-898-9433
Provider Enumeration Date:
12/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ARNOLD
Authorized Official First Name:
BILL
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
208-855-0660

Provider Taxonomy Codes

  • Taxonomy code: 103TF0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com