Healthcare Provider Details

I. General information

NPI: 1245580307
Provider Name (Legal Business Name): CHATHOLIC CHARITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 EUCLID AVE
CLEVELAND OH
44115-2531
US

IV. Provider business mailing address

3135 EUCLID AVE
CLEVELAND OH
44115-2531
US

V. Phone/Fax

Practice location:
  • Phone: 216-432-0682
  • Fax:
Mailing address:
  • Phone: 216-432-0682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License NumberS0009131
License Number StateOH

VIII. Authorized Official

Name: MS. JULIE ELLEN MARK
Title or Position: COUNSELOR
Credential: LSW
Phone: 216-432-0682