MEDICARE: EASTSIDE CATHOLIC CENTER & SHELTER

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1104927417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTSIDE CATHOLIC CENTER & SHELTER

Provider Business Mailing Address
First Line	:	PO BOX 20177
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-0177
Country	:	US
Telephone Number	:	216-231-5556
Fax Number	:	216-231-3993

Provider Business Practice Location Address
First Line	:	11701 SHAKER BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1956
Country	:	US
Telephone Number	:	216-231-5556
Fax Number	:	216-231-3993

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. MICHELLE BURLEY-KEYS
Credential	:
Telephone Number	:	216-231-5556

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/22/2020

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