Healthcare Provider Details

I. General information

NPI: 1134229156
Provider Name (Legal Business Name): OVERLOOK HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2187 OVERLOOK RD
CLEVELAND OH
44106-2323
US

IV. Provider business mailing address

2187 OVERLOOK RD
CLEVELAND OH
44106-2323
US

V. Phone/Fax

Practice location:
  • Phone: 216-795-3550
  • Fax: 216-795-0665
Mailing address:
  • Phone: 216-795-3550
  • Fax: 216-795-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: DIANA B. HENN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-795-3550