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)
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
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.