Healthcare Provider Details

I. General information

NPI: 1104699412
Provider Name (Legal Business Name): TEJENAE JORDAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13619 RYBAK AVE
GARFIELD HEIGHTS OH
44125-5236
US

IV. Provider business mailing address

13619 RYBAK AVE
GARFIELD HEIGHTS OH
44125-5236
US

V. Phone/Fax

Practice location:
  • Phone: 216-219-0665
  • Fax:
Mailing address:
  • Phone: 216-219-0665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: