1164577904 NPI number — COUNTY OF CUYAHOGA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164577904 NPI number — COUNTY OF CUYAHOGA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF CUYAHOGA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CUYAHOGA COUNTY BOARD OF HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164577904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5550 VENTURE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARMA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44130-9315
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-201-2001
Provider Business Mailing Address Fax Number:
216-676-1311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5550 VENTURE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARMA
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44130-9315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-201-2001
Provider Business Practice Location Address Fax Number:
216-676-1311
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STEWART
Authorized Official First Name:
MARCIEA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL CREDENTIALING MGR.
Authorized Official Telephone Number:
216-201-2001

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QA0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0860859 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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