Jordan Community Residential Center
NPI 1164068524 · Addiction (Substance Use Disorder) Psychologist · Willoughby, OH
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Jordan Community Residential Center is a Addiction (Substance Use Disorder) Psychologist organization in Willoughby, OH (NPI 1164068524).
Provider details
- NPI number
- 1164068524
- Entity type
- Organization
- Primary specialty
- Addiction (Substance Use Disorder) PsychologistBehavioral Health & Social Service Providers
- Organization subpart
- No
- Authorized official
- Tenisha Gant, Chief Executive Officer(216) 441-2496
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
6 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2019-11-20
- Last updated
- 2025-02-04
- Certified
- 2025-02-04
Frequently asked questions
- What is Jordan Community Residential Center's NPI number?
- Jordan Community Residential Center's National Provider Identifier (NPI) is 1164068524, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Jordan Community Residential Center?
- Jordan Community Residential Center is classified in the NPPES registry as Addiction (Substance Use Disorder) Psychologist (Behavioral Health & Social Service Providers).
- Where is Jordan Community Residential Center located?
- Jordan Community Residential Center's practice location on file with NPPES is 30841 Euclid Ave Ste 103, Willoughby, OH 44094-3100.
- What is Jordan Community Residential Center's phone number?
- The practice phone number listed in the NPPES registry for Jordan Community Residential Center is (216) 441-2496.
- Does Jordan Community Residential Center accept Medicare?
- Jordan Community Residential Center is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Jordan Community Residential Center?
- The authorized official listed on Jordan Community Residential Center's NPPES record is Tenisha Gant, Chief Executive Officer. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Jordan Community Residential Center's NPI active?
- Yes — Jordan Community Residential Center's NPI (1164068524) is active in the NPPES registry as of the last update on 2025-02-04.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.