Healthcare Provider Details

I. General information

NPI: 1164131777
Provider Name (Legal Business Name): ST VINCENT CHARITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2351 E 22ND ST
CLEVELAND OH
44115-3111
US

IV. Provider business mailing address

2351 E 22ND ST
CLEVELAND OH
44115-3111
US

V. Phone/Fax

Practice location:
  • Phone: 216-363-2538
  • Fax: 216-694-4604
Mailing address:
  • Phone:
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRADLEY RAUH
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 216-363-3000