Provider Demographics
NPI:1730805433
Name:SAROUKHAN, JORDAN GUY
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:GUY
Last Name:SAROUKHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4886 W STREETSBORO RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9560
Mailing Address - Country:US
Mailing Address - Phone:216-240-4457
Mailing Address - Fax:
Practice Address - Street 1:3916 HYDE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1328
Practice Address - Country:US
Practice Address - Phone:216-240-4457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker