Healthcare Provider Details

I. General information

NPI: 1376316547
Provider Name (Legal Business Name): MIKLAT RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23412 COMMERCE PARK
BEACHWOOD OH
44122-5813
US

IV. Provider business mailing address

23412 COMMERCE PARK
BEACHWOOD OH
44122-5813
US

V. Phone/Fax

Practice location:
  • Phone: 216-400-6640
  • Fax: 216-920-6215
Mailing address:
  • Phone: 216-400-6640
  • Fax: 216-920-6215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AHARON FERGUSSON
Title or Position: CEO
Credential:
Phone: 216-400-6640