NPIMap

Organization Active NPI

Jordan Community Residential

  • Mental Health Counselor
  • Willoughby, OH
National Provider Identifier
1467098822
Registry record updated Apr 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
JORDAN COMMUNITY RESIDENTIAL
Practice address
30841 Euclid Ave Ste 103
Willoughby, OH 44094-3100
Phone
(216) 441-2496
Fax
(216) 634-9611
NPI assigned
Nov 20, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tenisha GantNPI 1073136594
Title
Chief Executive Officer
Phone
(216) 441-2496

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

30841 Euclid Ave Ste 103
Willoughby, OH 44094-3100

Mailing address

30841 Euclid Ave Ste 103
Willoughby, OH 44094-3100
Phone (216) 441-2496

National Provider Directory

National Provider Directory
Tax ID family
Jordan Community Residential2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

30841 Euclid Ave
Ste 103
Willoughby, OH 44094
Phone (216) 441-2496

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1574208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1714089600000",
    "number": "1467098822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30841 EUCLID AVE STE 103",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440943100",
            "telephone_number": "216-441-2496",
            "fax_number": "216-634-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30841 EUCLID AVE STE 103",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440943100",
            "telephone_number": "216-441-2496",
            "fax_number": "216-634-9611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JORDAN COMMUNITY RESIDENTIAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-20",
        "last_updated": "2024-04-26",
        "certification_date": "2024-04-24",
        "status": "A",
        "authorized_official_last_name": "GANT",
        "authorized_official_first_name": "TENISHA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "216-441-2496"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.