1750690657 NPI number — CLEVELAND HEALTH MANAGEMENT INC

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 1750690657 NPI number — CLEVELAND HEALTH MANAGEMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLEVELAND HEALTH MANAGEMENT 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:
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:
1750690657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16781 CHAGRIN BLVD
Provider Second Line Business Mailing Address:
# 282
Provider Business Mailing Address City Name:
SHAKER HEIGHTS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44120-3721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-548-6244
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11201 SHAKER BLVD
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:
44104-3869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-548-6244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KIOUS
Authorized Official First Name:
ALFRED
Authorized Official Middle Name:
GUS
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
216-548-6244

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35042555 , 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)





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