MEDICARE: FYP 1421 LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	175T00000X	Peer Specialist
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
3	101YA0400X	Addiction (Substance Use Disorder) Counselor
4	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
5	104100000X	Social Worker
6	101YM0800X	Mental Health Counselor
7	261QM0855X	Adolescent and Children Mental Health Clinic/Center
8	171M00000X	Case Manager/Care Coordinator
9	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1013849884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FYP 1421 LLC

Provider Business Mailing Address
First Line	:	18104 WESTON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1039
Country	:	US
Telephone Number	:	216-712-0056
Fax Number	:

Provider Business Practice Location Address
First Line	:	18104 WESTON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1039
Country	:	US
Telephone Number	:	216-712-0056
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ZARELL PATTON
Credential	:
Telephone Number	:	216-712-0056

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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