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Organization
JORDAN COMMUNITY RESIDENTIAL CENTER
Active
Organization
JORDAN COMMUNITY RESIDENTIAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TENISHA GANT (CHIEF EXECUTIVE OFFICER)
(216) 441-2496
Entity
Organization
Contact information
Practice address
30841 EUCLID AVE STE 103, WILLOUGHBY, OH 44094-3100
(216) 441-2496
(216) 634-9611
Mailing address
30841 EUCLID AVE STE 103, WILLOUGHBY, OH 44094-3100
(216) 441-2496
(216) 634-9611
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
NULL
103TA0400X
Addiction (Substance Use Disorder) Psychologist
Primary
—
—
Other
Enumeration date
11/20/2019
Last updated
02/04/2025
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