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NPI Code Detail

MEDICARE: SHAKER HEIGHTS YOUTH CENTER

MEDICARE: SHAKER HEIGHTS YOUTH CENTER
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
1251V00000XVoluntary or Charitable AgencyN/A

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101081OTHEROHODADAS UPI

General Provider Information

NPI Number : 1851355960
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHAKER HEIGHTS YOUTH CENTER
Provider Business Mailing Address
First Line : 17300 VAN AKEN BLVD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44120-3460
Country : US
Telephone Number : 216-752-9292
Fax Number : 216-752-7217
Provider Business Practice Location Address
First Line : 17300 VAN AKEN BLVD
Second Line :
City : SHAKER HEIGHTS
State : OH
Zip : 44120-3460
Country : US
Telephone Number : 216-752-9292
Fax Number : 216-752-7217
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. JOHN JAMES LISY
Credential : LISW,LPCC,LICDC,OCPS
Telephone Number : 216-752-9292
Provider Enumeration Date : 04/14/2006
Last Update Date : 08/22/2020

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Directions to “SHAKER HEIGHTS YOUTH CENTER ” Practice Location

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