Provider Demographics
NPI:1003785486
Name:WOODS, JORDAN MICHELLE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MICHELLE
Last Name:WOODS
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 1:203 S 77TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1513
Mailing Address - Country:US
Mailing Address - Phone:509-388-5693
Mailing Address - Fax:509-966-1031
Practice Address - Street 1:203 S 77TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1513
Practice Address - Country:US
Practice Address - Phone:509-388-5693
Practice Address - Fax:509-966-1031
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-03
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA758359310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility