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Contact Information

JORDAN COMMUNITY RESIDENTIAL CENTER
30841 EUCLID AVE STE 103
WILLOUGHBY, OH44094-3100
 Phone: 216-441-2496
 Fax: 216-634-9611
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Addiction (Substance Use Disorder)

103TA0400X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for JORDAN COMMUNITY RESIDENTIAL CENTER

NPI # 1164068524
LBN Legal business name JORDAN COMMUNITY RESIDENTIAL CENTER
Authorized official TENISHA GANT - (CHIEF EXECUTIVE OFFICER)
Entity Organization
Organization subpart 1 No
Enumeration date 11/20/2019
Last updated 02/04/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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