Healthcare Provider Details

I. General information

NPI: 1063147361
Provider Name (Legal Business Name): ST. VINCENT CHARITY HEALTH CAMPUS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 E 22ND ST
CLEVELAND OH
44115-3111
US

IV. Provider business mailing address

2475 E 22ND ST FL 5
CLEVELAND OH
44115-3209
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-7000
  • Fax:
Mailing address:
  • Phone: 216-363-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL J BISCARO
Title or Position: VICE PRESIDENT, BEHAVIORAL HEALTH
Credential: PSY.D.
Phone: 216-363-7010