Healthcare Provider Details

I. General information

NPI: 1447403621
Provider Name (Legal Business Name): CITY OF CLEVELAND DEPT. OF PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 LORAIN AVE
CLEVELAND OH
44113-3715
US

IV. Provider business mailing address

75 ERIEVIEW PLZ FL 2
CLEVELAND OH
44114-1839
US

V. Phone/Fax

Practice location:
  • Phone: 216-651-5005
  • Fax:
Mailing address:
  • Phone: 216-664-4371
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MATTHEW CARROLL
Title or Position: DIRECTOR OF HEALTH
Credential: JD
Phone: 216-664-6790