| Jeanettes Sanctuary Llc | |
|
38780 Chestnut Ridge Rd Elyria OH 44035-8232 | |
| (440) 219-4004 | |
| Not Available |
| Full Name | Jeanettes Sanctuary Llc |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Mental Illness |
| Location | 38780 Chestnut Ridge Rd, Elyria, Ohio |
| Authorized Official Name and Position | Latasha Monique Gordon (FOUNDER/CEO) |
| Authorized Official Contact | 4406576446 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeanettes Sanctuary Llc 113 Lexington Ave Elyria OH 44035-6217 Ph: (440) 657-6446 | Jeanettes Sanctuary Llc 38780 Chestnut Ridge Rd Elyria OH 44035-8232 Ph: (440) 219-4004 |
| NPI Number | 1710788419 |
|---|---|
| Provider Enumeration Date | 03/20/2025 |
| Last Update Date | 03/20/2025 |
| Certification Date | 03/20/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710788419 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 320800000X | Community Based Residential Treatment Facility, Mental Illness | (* (Not Available)) | Primary |
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