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NPI Code Detail

MEDICARE: CLEVELAND CHRISTIAN HOME

MEDICARE: CLEVELAND CHRISTIAN HOME
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
1320800000XMental Illness Community Based Residential Treatment Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110258OTHEROHUPI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487922860
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEVELAND CHRISTIAN HOME
Provider Business Mailing Address
First Line : 3146 SCRANTON RD
Second Line :
City : CLEVELAND
State : OH
Zip : 44109-1652
Country : US
Telephone Number : 216-688-4129
Fax Number : 216-941-2080
Provider Business Practice Location Address
First Line : 11401 LORAIN AVE
Second Line :
City : CLEVELAND
State : OH
Zip : 44111-5428
Country : US
Telephone Number : 216-688-4129
Fax Number : 216-941-2080
Authorized Official
Title or Position : CEO
Name : MR. DAVID LUNDEEN
Credential :
Telephone Number : 216-671-0997
Provider Enumeration Date : 12/13/2011
Last Update Date : 12/13/2011

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Directions to “CLEVELAND CHRISTIAN HOME ” Practice Location

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