Healthcare Provider Details

I. General information

NPI: 1811238215
Provider Name (Legal Business Name): CARRINGTON YOUTH ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2114 NOBLE RD
CLEVELAND OH
44112-1725
US

IV. Provider business mailing address

2114 NOBLE RD
CLEVELAND OH
44112-1725
US

V. Phone/Fax

Practice location:
  • Phone: 216-268-2400
  • Fax: 216-268-2460
Mailing address:
  • Phone: 216-268-2400
  • Fax: 216-268-2460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number0698
License Number StateOH

VIII. Authorized Official

Name: MR. BERNARD F PAWLIKOWSKY
Title or Position: ADMINISTRATOR
Credential:
Phone: 216-268-2400