Healthcare Provider Details

I. General information

NPI: 1174401970
Provider Name (Legal Business Name): KINGDOM BUILDERS TRANSITIONAL HOUSING PROGRAM OF OHIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3043 SUPERIOR AVE STE 202
CLEVELAND OH
44114-4349
US

IV. Provider business mailing address

3659 GREEN RD STE 220
BEACHWOOD OH
44122-5715
US

V. Phone/Fax

Practice location:
  • Phone: 330-805-6337
  • Fax:
Mailing address:
  • Phone: 330-805-6337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KERRIE JAMES-HUNTER
Title or Position: ADMINISTRATOR
Credential:
Phone: 330-805-6337