Healthcare Provider Details

I. General information

NPI: 1619468188
Provider Name (Legal Business Name): EARL MCDONALD CMS-HS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2018
Last Update Date: 10/29/2021
Certification Date: 10/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 WINSLOW AVE
CLEVELAND OH
44113-2336
US

IV. Provider business mailing address

1320 WASHINGTON AVE
CLEVELAND OH
44113-2333
US

V. Phone/Fax

Practice location:
  • Phone: 216-727-2086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: