1619934676 NPI number — BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.

Table of content: (NPI 1619934676)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619934676 NPI number — BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUREAU OF DRUG ABUSE,CLEVELAND TREATMENT CENTER,INC.
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:
Provider Other Organization Name Type Code:
6
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:
1619934676
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1127 CARNEGIE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44115-2805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-861-4246
Provider Business Mailing Address Fax Number:
216-861-1156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 CARNEGIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44115-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-861-4246
Provider Business Practice Location Address Fax Number:
216-861-1156
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COLLINS
Authorized Official First Name:
LEONARD
Authorized Official Middle Name:
CHARLES LEE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
216-861-4246

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  020263800 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 980477 . This is a "ODADAS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 79198 . This is a "CARF (PREVENTION ATOD)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 35056916 . This is a "STATE BOARD OF PHARMACY" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 38743 . This is a "CARF(OPIOIDOTP)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1094 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1522088 . This is a "FDA" identifier . This identifiers is of the category "OTHER".




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