Provider Demographics
NPI:1609612175
Name:JORDANS PROMISE-POINT
Entity type:Organization
Organization Name:JORDANS PROMISE-POINT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANTAVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:AVINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-776-9568
Mailing Address - Street 1:15655 SCOLTY REACH LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4919
Mailing Address - Country:US
Mailing Address - Phone:832-776-9568
Mailing Address - Fax:
Practice Address - Street 1:15655 SCOLTY REACH LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4919
Practice Address - Country:US
Practice Address - Phone:832-776-9568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty