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JORDAN COMMUNITY RESIDENTIAL CENTER
NPI 1164068524
Psychologist - Addiction (Substance Use Disorder) in Willoughby, OH

Active since November 20, 2019CLIA 36D2299306 · Waiver
30841 EUCLID AVE STE 103, WILLOUGHBY, OH 44094(216) 441-2496(216) 634-9611 Get Directions Write a Review

NPPES record last updated: February 4, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 4, 2025, Apr 26, 2024, Nov 20, 2019 (3 updates tracked since 2019).

About Jordan Community Residential Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JORDAN COMMUNITY RESIDENTIAL CENTER (NPI 1164068524) is a healthcare organization registered as an addiction (substance use disorder) in Willoughby, Ohio and active in the NPI registry since November 2019. The organization holds a CLIA Waiver certificate valid through February 15, 2028 and lists Tenisha Gant, Chief Executive Officer, as its authorized official.

NPPES Registry Identity

NPI1164068524
Entity TypeOrganization
Primary Taxonomy103TA0400X
Legal Business NameJORDAN COMMUNITY RESIDENTIAL CENTER
Location Address30841 EUCLID AVE STE 103Willoughby, OH 44094-3100
Mailing Address30841 Euclid Ave Ste 103Willoughby, OH 44094-3100 · (216) 441-2496 · Fax (216) 634-9611
Phone(216) 441-2496
Fax(216) 634-9611
Organization SubpartNo
Authorized OfficialTenisha GantChief Executive Officer · (216) 441-2496
Enumeration DateNovember 20, 2019
Last NPPES UpdateFebruary 4, 20253 updates tracked since enumeration
NPPES CertifiedFebruary 4, 2025
✔ NPI 1164068524 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code103TA0400X
Definition
A psychologist with a proficiency that involves the application of psychological treatment of addiction stemming from the use of alcohol and other psychoactive substances (e.g., nicotine, marijuana, cocaine, heroin) or behavioral addictions (e.g., gambling) with the aim of cessation or reduction of use and/or the amelioration of emotional, behavioral, interpersonal and other problems arising from the addictive behavior.
30841 EUCLID AVE STE 103, Willoughby, OH 44094
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 36D2299306

Jordan Community Residential Center · Willoughby, OH
Active · expires Feb 15, 2028
CLIA Number36D2299306
Laboratory TypeCommunity Clinic
Certificate Effective DateFebruary 16, 2026
Certificate Expiration DateFebruary 15, 2028
Laboratory DirectorFelicia Harris
Laboratory Phone(216) 441-2496
Laboratory LocationJordan Community Residential Center30851 Euclid Ave, Willoughby, OH 44094
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOCELYN GARDNER SWT
Counselor
30841 EUCLID AVE STE 103
WILLOUGHBY, OH 44094
Lake County (216) 441-2496
JENNIFER LOPEZ CDCA
Counselor (Addiction (Substance Use Disorder))
30841 EUCLID AVE STE 103
WILLOUGHBY, OH 44094
Lake County (216) 441-2496
JORDAN COMMUNITY RESIDENTIAL
Counselor (Mental Health)
30841 EUCLID AVE STE 103
WILLOUGHBY, OH 44094
Lake County (216) 441-2496
VASCHEZ C WESTMORELAND CDCA
Counselor (Addiction (Substance Use Disorder))
30841 EUCLID AVE STE 103
WILLOUGHBY, OH 44094
Lake County (216) 441-2496
MS. JOYE E TOOMBS LSW
Social Worker
30841 EUCLID AVE STE 103
WILLOUGHBY, OH 44094
Lake County (216) 441-2496
ALICIA DEXTER CDCA
Counselor (Addiction (Substance Use Disorder))
30841 EUCLID AVE STE 103
WILLOUGHBY, OH 44094
Lake County (216) 441-2496

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jordan Community Residential Center's NPI number?

The NPI number for Jordan Community Residential Center is 1164068524. It was assigned to this organization in the NPPES registry on November 20, 2019.

Where is Jordan Community Residential Center located?

Jordan Community Residential Center is located at 30841 Euclid Ave Ste 103, Willoughby, OH 44094. The listed phone number is (216) 441-2496.

What is Jordan Community Residential Center's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Addiction (Substance Use Disorder), with taxonomy code 103TA0400X.

Does Jordan Community Residential Center hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 36D2299306) is associated with this NPI, valid through February 15, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Jordan Community Residential Center accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Anthem Blue Cross and Blue Shield and Molina Healthcare list Jordan Community Residential Center as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jordan Community Residential Center was last updated on February 4, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.