Healthcare Provider Details

I. General information

NPI: 1295167682
Provider Name (Legal Business Name): APPLEWOOD CENTERS FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2013
Last Update Date: 08/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3518 W 25TH ST
CLEVELAND OH
44109-1951
US

IV. Provider business mailing address

4616 MCFARLAND RD
SOUTH EUCLID OH
44121-3412
US

V. Phone/Fax

Practice location:
  • Phone: 216-571-0889
  • Fax:
Mailing address:
  • Phone: 216-571-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberS.1302859
License Number StateOH

VIII. Authorized Official

Name: MS. KELLY TILLEY
Title or Position: DIRECTOR
Credential: M.A., L.P.C.C.-S
Phone: 216-521-6511