Jeanettes Sanctuary LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

JEANETTES SANCTUARY LLC

Practice address

38780 Chestnut Ridge Rd
Elyria, OH 44035-8232

Phone

(440) 219-4004

NPI assigned

Mar 20, 2025

Last updated

Mar 20, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Latasha Monique Gordon, LPC, LICDC, OCPSANPI 1922459072

Title

Founder/Ceo

Phone

(440) 657-6446

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Latasha Monique Gordon, LICDC, LPC

  • Addiction (Substance Use Disorder) Counselor
  • Parma, OH
  • NPI 1922459072
  NPD Authorized official

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

{
    "created_epoch": "1742428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742428800000",
    "number": "1710788419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LEXINGTON AVE",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440356217",
            "telephone_number": "440-657-6446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38780 CHESTNUT RIDGE RD",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440358232",
            "telephone_number": "440-219-4004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEANETTES SANCTUARY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-20",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "LATASHA",
        "authorized_official_middle_name": "MONIQUE",
        "authorized_official_title_or_position": "FOUNDER/CEO",
        "authorized_official_telephone_number": "440-657-6446",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPC, LICDC, OCPSA"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaniqua Aqueen James
• Matthew Janik, MD
• Jaworski Physical Therapy Inc
• Jaworski Physical Therapy Inc
• Michael J Jaworski, PT
• Scarlett Jefferson
• Molly Jeffrey
• Noah Jenkins, PA-C
• Jessica Archer Therapy Services
• Brittany Marie Jewell

• Mental Illness Community Based Residential Treatment Facility in Elyria, OH
• Providers in Elyria, OH by specialty
• Mental Illness Community Based Residential Treatment Facility in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2025; 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.