Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jordan Community Residential Center

Organization Addiction (Substance Use Disorder) Psychologist · NPI 1164068524

Jordan Community Residential Center is an Addiction (Substance Use Disorder) Psychologist in Willoughby, Ohio. Registered with an NPI since 2019.

In the registry since
2019
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Practice location Address checks out

30841 Euclid Ave Ste 103
Willoughby, OH 44094-3100
Phone: (216) 441-2496
Fax: (216) 634-9611
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Addiction (Substance Use Disorder) Psychologist (primary) Taxonomy 103TA0400X

Record details

NPI number1164068524
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tenisha Gant — Chief Executive Officer · (216) 441-2496
NPI enumeratedNovember 20, 2019
Last updated in NPPESFebruary 4, 2025
Certification dateFebruary 4, 2025
Mailing address30841 Euclid Ave Ste 103, Willoughby, OH 44094-3100

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