Healthcare Provider Details

I. General information

NPI: 1972149268
Provider Name (Legal Business Name): NEW MANNA CLG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25501 CHAGRIN BLVD
BEACHWOOD OH
44122-5603
US

IV. Provider business mailing address

PO BOX 74769
CLEVELAND OH
44194-0852
US

V. Phone/Fax

Practice location:
  • Phone: 216-545-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE GALLUCCI
Title or Position: VP CHIEF ACCOUNTING OFFICER
Credential:
Phone: 440-382-7894