| |
1660 Plum Ln Redlands CA 92374-4532 | |
(909) 881-1031 | |
Not Available |
Full Name | |
---|---|
Speciality | Psychiatry & Neurology |
Location | 1660 Plum Ln, Redlands, California |
Authorized Official Name and Position | Kenneth George Jordan (PRESIDENT / OWNER) |
Authorized Official Contact | 9098811031 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
1660 Plum Ln Redlands CA 92374-4532 Ph: (909) 881-1031 | 1660 Plum Ln Redlands CA 92374-4532 Ph: (909) 881-1031 |
NPI Number | 1851510663 |
---|---|
Provider Enumeration Date | 04/24/2007 |
Last Update Date | 07/09/2024 |
Certification Date | 07/09/2024 |
Medicare PECOS PAC ID | 6709970387 |
---|---|
Medicare Enrollment ID | O20070913000745 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851510663 | NPI | - | NPPES |
00G283910 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
Provider Name | Kenneth Jordan |
---|---|
Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1477537116 PECOS PAC ID: 1254425820 Enrollment ID: I20070913000739 |
San Bernardino County Superintendent Of Schools Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1812 W Park Ave, Redlands, CA 92373 Phone: 909-748-0259 | |
Inlandpsych Redlands Inc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 255 Terracina Blvd, Suite 204, Redlands, CA 92373 Phone: 909-798-1763 | |
Creative Change Therapy Center, A Clinical Social Worker Corp Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1255 W Colton Ave # 614, Redlands, CA 92374 Phone: 760-699-4199 | |