Healthcare Provider Details

I. General information

NPI: 1225446321
Provider Name (Legal Business Name): DEMER RETAIL VENTURES MH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 WESTGATE D416
FAIRVIEW PARK OH
44126-1331
US

IV. Provider business mailing address

3505 WESTGATE D416
FAIRVIEW PARK OH
44126-1331
US

V. Phone/Fax

Practice location:
  • Phone: 440-973-8627
  • Fax:
Mailing address:
  • Phone: 440-973-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: DAVID ADRIAN DEMER
Title or Position: PRESIDENT
Credential:
Phone: 216-408-1054