Healthcare Provider Details

I. General information

NPI: 1720278112
Provider Name (Legal Business Name): INNER CITY LIVING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 09/15/2024
Certification Date: 09/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10323 SLADDEN AVE
CLEVELAND OH
44125-1560
US

IV. Provider business mailing address

10323 SLADDEN AVE
CLEVELAND OH
44125-1560
US

V. Phone/Fax

Practice location:
  • Phone: 216-288-4997
  • Fax:
Mailing address:
  • Phone: 216-288-4997
  • Fax: 216-650-8568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number2711775
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number2711775
License Number StateOH

VIII. Authorized Official

Name: LANIECE DAVIS
Title or Position: PRESIDENT
Credential:
Phone: 216-288-4997