Healthcare Provider Details

I. General information

NPI: 1730847831
Provider Name (Legal Business Name): FAMILY PROMISE OF GREATER CLEVELAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3470 E 152ND ST
CLEVELAND OH
44120-4242
US

IV. Provider business mailing address

3470 E 152ND ST
CLEVELAND OH
44120-4242
US

V. Phone/Fax

Practice location:
  • Phone: 216-767-4060
  • Fax:
Mailing address:
  • Phone: 216-767-4060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JACQUELINE SUSAN SALTER
Title or Position: EXECUTIVE DIRECTOR
Credential: PCC-S, LMFT
Phone: 216-767-4061