Provider Demographics
NPI:1578366894
Name:CRABTREE, JORDAN BROOKE (NCCHHA, ANCCHHA, ALM)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:BROOKE
Last Name:CRABTREE
Suffix:
Gender:
Credentials:NCCHHA, ANCCHHA, ALM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 NC HIGHWAY 86 N
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8225
Mailing Address - Country:US
Mailing Address - Phone:919-951-9362
Mailing Address - Fax:
Practice Address - Street 1:607 NC HIGHWAY 86 N
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8225
Practice Address - Country:US
Practice Address - Phone:919-951-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 172V00000X, 251G00000X, 302R00000X, 347C00000X, 372500000X, 376K00000X
NC20251168P253Z00000X, 372600000X, 3747P1801X, 374U00000X, 376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376G00000XNursing Service Related ProvidersNursing Home Administrator
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No172V00000XOther Service ProvidersCommunity Health Worker
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No347C00000XTransportation ServicesPrivate Vehicle
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide