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NPI Code Detail

MEDICARE: RILEY SIMPLICAN CDCA

MEDICARE: RILEY SIMPLICAN CDCA
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 FacilityCDCA.176354OH

General Provider Information

NPI Number : 1790367183
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY SIMPLICAN CDCA
Provider Business Mailing Address
First Line : 1804 E 55TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-3602
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1804 E 55TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44103-3602
Country : US
Telephone Number : 216-417-4213
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2021
Last Update Date : 04/25/2021

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Directions to “ RILEY SIMPLICAN CDCA” Practice Location

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