Healthcare Provider Details

I. General information

NPI: 1063296465
Provider Name (Legal Business Name): CLEVELAND ARTS AND WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 DETROIT AVE APT 410
CLEVELAND OH
44102-1871
US

IV. Provider business mailing address

9520 DETROIT AVE APT 410
CLEVELAND OH
44102-1871
US

V. Phone/Fax

Practice location:
  • Phone: 216-323-5914
  • Fax:
Mailing address:
  • Phone: 216-323-5914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ELIJAH W GILMORE
Title or Position: HEALTH AND WELLNESS
Credential:
Phone: 216-323-5914