MEDICARE: NORTHERN OHIO RECOVERY ASSOCIATION

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	251S00000X	Community/Behavioral Health Agency	12603	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12379	OTHER	OH	1

General Provider Information

NPI Number	:	1598825069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN OHIO RECOVERY ASSOCIATION

Provider Business Mailing Address
First Line	:	3746 PROSPECT AVE E
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-2706
Country	:	US
Telephone Number	:	216-392-6672
Fax Number	:	216-392-4633

Provider Business Practice Location Address
First Line	:	2114 NOBLE RD
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-1725
Country	:	US
Telephone Number	:	216-229-3784
Fax Number	:	216-229-2746

Authorized Official
Title or Position	:	EXECITIVE DIRECTOR
Name	:	MISS ANITA BERTRAND
Credential	:	MSW,LSW,LICDC
Telephone Number	:	216-391-6672

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	09/24/2008

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Directions to “NORTHERN OHIO RECOVERY ASSOCIATION ” Practice Location

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