Jordan Community Residential Center
Psychologist, Addiction (Substance Use Disorder) in Willoughby, OH. Organization (NPI-2).
NPI number1164068524
StatusActive
Last updated in NPPESFeb 4, 2025
Details
- NPI
- 1164068524
- Entity type
- Organization (NPI-2)
- Legal business name
- Jordan Community Residential Center
- Organization subpart
- No
- Enumeration date
- Nov 20, 2019
- Certification date
- Feb 4, 2025
- Last updated
- Feb 4, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103TA0400X | Psychologist, Addiction (Substance Use Disorder) | – | – | Yes |
Practice location
30841 Euclid Ave Ste 103Willoughby, OH 44094-3100
Phone 216-441-2496 · Fax 216-634-9611
Mailing address
30841 Euclid Ave Ste 103Willoughby, OH 44094-3100
Phone 216-441-2496 · Fax 216-634-9611
Authorized official
Tenisha Gant
Chief Executive Officer
2164412496
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