Healthcare Provider Details

I. General information

NPI: 1093639296
Provider Name (Legal Business Name): BACK TO BASICS YOUTH AND FAMILY FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 ARCHMERE AVE
CLEVELAND OH
44109-5400
US

IV. Provider business mailing address

3301 ARCHMERE AVE
CLEVELAND OH
44109-5400
US

V. Phone/Fax

Practice location:
  • Phone: 216-346-8608
  • Fax: 216-273-7974
Mailing address:
  • Phone: 216-346-8608
  • Fax: 216-273-7974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA V SAMPSON
Title or Position: EXECUTIVE DIRECTOR
Credential: MS.MSW.MA.LICDC. PRS
Phone: 216-346-8608