| Jordan Community Residential | |
|
30841 Euclid Ave Ste 103 Willoughby OH 44094-3100 | |
| (216) 441-2496 | |
| (216) 634-9611 |
| Full Name | Jordan Community Residential |
|---|---|
| Speciality | Psychologist - Addiction (substance Use Disorder) |
| Location | 30841 Euclid Ave Ste 103, Willoughby, Ohio |
| Authorized Official Name and Position | Tenisha Gant (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2164412496 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jordan Community Residential 30841 Euclid Ave Ste 103 Willoughby OH 44094-3100 Ph: (216) 441-2496 | Jordan Community Residential 30841 Euclid Ave Ste 103 Willoughby OH 44094-3100 Ph: (216) 441-2496 |
| NPI Number | 1164068524 |
|---|---|
| Provider Enumeration Date | 11/20/2019 |
| Last Update Date | 04/26/2024 |
| Certification Date | 04/24/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164068524 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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