Healthcare Provider Details

I. General information

NPI: 1184572588
Provider Name (Legal Business Name): CLEVELAND RISE RESIDENTIAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 FORD DR APT 808
CLEVELAND OH
44106-5111
US

IV. Provider business mailing address

1990 FORD DR APT 808
CLEVELAND OH
44106-5111
US

V. Phone/Fax

Practice location:
  • Phone: 216-937-5355
  • Fax:
Mailing address:
  • Phone: 216-704-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: YOKO FERRELL
Title or Position: CO-OWNER
Credential: FERRELL
Phone: 216-937-5355