Healthcare Provider Details

I. General information

NPI: 1760396675
Provider Name (Legal Business Name): RONISHA JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 E 200TH ST
EUCLID OH
44119-2504
US

IV. Provider business mailing address

20200 GOLLER AVE
EUCLID OH
44119-1835
US

V. Phone/Fax

Practice location:
  • Phone: 216-774-9180
  • Fax:
Mailing address:
  • Phone: 216-212-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: