Healthcare Provider Details

I. General information

NPI: 1093816209
Provider Name (Legal Business Name): BEECH BROOK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13201 GRANGER RD STE 8
GARFIELD HEIGHTS OH
44125-1979
US

IV. Provider business mailing address

13201 GRANGER RD STE 8
GARFIELD HEIGHTS OH
44125-1979
US

V. Phone/Fax

Practice location:
  • Phone: 216-831-2255
  • Fax: 216-831-0436
Mailing address:
  • Phone: 216-831-2255
  • Fax: 216-831-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number208
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number12773
License Number StateOH

VIII. Authorized Official

Name: MR. THOMAS ROYER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MPA
Phone: 216-831-2255