Healthcare Provider Details

I. General information

NPI: 1902546815
Provider Name (Legal Business Name): SEMADAR ESKRIDGE CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 03/30/2022
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 ANSEL RD
CLEVELAND OH
44108-3323
US

IV. Provider business mailing address

1227 ANSEL RD
CLEVELAND OH
44108-3323
US

V. Phone/Fax

Practice location:
  • Phone: 216-421-0662
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.178029
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: