Healthcare Provider Details

I. General information

NPI: 1184194045
Provider Name (Legal Business Name): NEAR WEST SIDE MULTI SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2018
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 BRIDGE AVE
CLEVELAND OH
44113-3304
US

IV. Provider business mailing address

4115 BRIDGE AVE
CLEVELAND OH
44113-3304
US

V. Phone/Fax

Practice location:
  • Phone: 216-631-5800
  • Fax: 216-631-4595
Mailing address:
  • Phone: 216-631-5800
  • Fax: 216-631-4595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICK A KEMM
Title or Position: EXECUTIVE DIRECTOR
Credential: MNO
Phone: 216-631-5800