Healthcare Provider Details

I. General information

NPI: 1235414830
Provider Name (Legal Business Name): CLEVELAND HEALTH VENTURES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 E. KING STREET
KINGS MOUNTAIN NC
28086-3186
US

IV. Provider business mailing address

PO BOX 601884
CHARLOTTE NC
28260-1884
US

V. Phone/Fax

Practice location:
  • Phone: 980-487-2700
  • Fax: 980-487-2701
Mailing address:
  • Phone: 980-487-2700
  • Fax: 980-487-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL WIENS
Title or Position: SENIOR VICE PRESIDENT-OPERATIONS
Credential:
Phone: 704-355-0648