Healthcare Provider Details

I. General information

NPI: 1750436465
Provider Name (Legal Business Name): CLEVELAND HEALTH VENTURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3326 BESSEMER CITY RD
BESSEMER CITY NC
28016-8781
US

IV. Provider business mailing address

PO BOX 601884
CHARLOTTE NC
28260-1884
US

V. Phone/Fax

Practice location:
  • Phone: 704-629-0412
  • Fax: 704-629-9454
Mailing address:
  • Phone: 704-629-0412
  • Fax: 704-629-9454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL L WIENS
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 704-355-7600