Provider Demographics
NPI:1861964165
Name:JORDAN DBA TRENT'S TEAM, THERESA A
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:A
Last Name:JORDAN DBA TRENT'S TEAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 E PIKES PEAK AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6781
Mailing Address - Country:US
Mailing Address - Phone:719-660-5663
Mailing Address - Fax:719-434-9603
Practice Address - Street 1:3812 E PIKES PEAK AVE STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-6781
Practice Address - Country:US
Practice Address - Phone:719-660-5663
Practice Address - Fax:719-434-9603
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-26
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child