Healthcare Provider Details

I. General information

NPI: 1740373992
Provider Name (Legal Business Name): EASTSIDE CATHOLIC CENTER & SHELTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13211 CHAPELSIDE AVE
CLEVELAND OH
44120-4605
US

IV. Provider business mailing address

PO BOX 20177
CLEVELAND OH
44120-0177
US

V. Phone/Fax

Practice location:
  • Phone: 216-231-5556
  • Fax: 216-231-3993
Mailing address:
  • Phone: 216-231-5556
  • Fax: 216-231-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MICHELLE BURLEY-KEYS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-231-5556