Healthcare Provider Details

I. General information

NPI: 1164387510
Provider Name (Legal Business Name): OHIO YOUTH WELLNESS & ENRICHMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16327 DELREY AVE
CLEVELAND OH
44128-1369
US

IV. Provider business mailing address

16327 DELREY AVE
CLEVELAND OH
44128-1369
US

V. Phone/Fax

Practice location:
  • Phone: 440-317-9980
  • Fax:
Mailing address:
  • Phone: 440-317-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: BIANCA M WILSON
Title or Position: OWNER
Credential:
Phone: 440-650-7215