Healthcare Provider Details

I. General information

NPI: 1568676765
Provider Name (Legal Business Name): CUYAHOGA COUNTY BD OF MRDD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 LEE RD
MAPLE HEIGHTS OH
44137-1227
US

IV. Provider business mailing address

1275 LAKESIDE AVE E
CLEVELAND OH
44114-1132
US

V. Phone/Fax

Practice location:
  • Phone: 216-736-2625
  • Fax: 216-736-2702
Mailing address:
  • Phone: 216-736-2625
  • Fax: 216-736-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number1811730
License Number StateOH

VIII. Authorized Official

Name: MR. TERRENCE RYAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 216-736-2625