Individual ProviderJordan BlackBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address584 E Bellevue Rd, Atwater, CA 95301-2300(559) 747-2177PECOS EnrollmentBased on the most recent information from CMS, provider Jordan Black does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 6:04 PM.Profile DetailsProvider ID1083363386Provider TypeIndividualFull NameBlack, JordanGenderFemaleSole ProprietorNoEnumeration Date3/22/2022Last Updated3/22/2022Contact InformationPractice LocationPractice Address584 E Bellevue Rd, Atwater, CA 95301-2300Phone(559) 747-2177FaxUnlisted FaxMailing LocationMailing Address584 E Bellevue Rd, Atwater, CA 95301-2300PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCalifornia