Healthcare Provider Details

I. General information

NPI: 1447342696
Provider Name (Legal Business Name): HISPANIC URBAN MINORITY ALCHOLISM AND DRUG ABUSE OUTREACH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 W 25TH ST
CLEVELAND OH
44109-1613
US

IV. Provider business mailing address

3305 W 25TH ST
CLEVELAND OH
44109-1613
US

V. Phone/Fax

Practice location:
  • Phone: 216-459-1222
  • Fax: 216-459-2696
Mailing address:
  • Phone: 216-459-1222
  • Fax: 216-459-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number00978
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13366
License Number StateOH

VIII. Authorized Official

Name: MS. SIOBHAN MALAVE
Title or Position: CLINICAL DIRECTOR
Credential: LISW-S, LICDC
Phone: 216-459-1222