Healthcare Provider Details

I. General information

NPI: 1366579021
Provider Name (Legal Business Name): CUYAHOGA COUNTY DEPARTMENT OF JUSTICE AFFAIRS DIVISION OF TREATMENT SE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 W 3RD ST STE 319
CLEVELAND OH
44113-1512
US

IV. Provider business mailing address

1276 W 3RD ST STE 319
CLEVELAND OH
44113-1512
US

V. Phone/Fax

Practice location:
  • Phone: 216-443-3750
  • Fax: 216-698-6524
Mailing address:
  • Phone: 216-443-7265
  • Fax: 216-698-6524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVEN J TERRY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-443-5905