Healthcare Provider Details

I. General information

NPI: 1316629827
Provider Name (Legal Business Name): MCREYNOLDS COMMUNITY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6014 ANDOVER BLVD STE 201
GARFIELD HEIGHTS OH
44125
US

IV. Provider business mailing address

815 SUPERIOR AVE E STE 1618
CLEVELAND OH
44114-2709
US

V. Phone/Fax

Practice location:
  • Phone: 216-612-2592
  • Fax:
Mailing address:
  • Phone: 216-612-2592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: ANGELA TAYLOR-MCREYNOLDS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 216-612-2592