Healthcare Provider Details

I. General information

NPI: 1780554576
Provider Name (Legal Business Name): JORDAN'S PLACE OF PEACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7659 JACKSON SCHOOL RD
BROWNS SUMMIT NC
27214-9706
US

IV. Provider business mailing address

3636 SWEET BIRCH DR
GREENSBORO NC
27406-9500
US

V. Phone/Fax

Practice location:
  • Phone: 336-402-0875
  • Fax:
Mailing address:
  • Phone: 336-402-0875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. TONYA LYNETTE HARDEN
Title or Position: OWNER/OPERATOR
Credential: RN, BSN
Phone: 336-402-0875