Basic Information
| Provider Information | |||||||||
| NPI: | 1093163768 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | JARDASHAI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5420 W SAHARA AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891460394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028827827 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 LOYOLA AVE STE 106 | ||||||||
| Address2: | |||||||||
| City: | NEW ORLEANS | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701131912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045589595 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2016 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.