Healthcare Provider Details

I. General information

NPI: 1245177526
Provider Name (Legal Business Name): INNER CITY PIRATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5202 BEECH AVE
MAPLE HEIGHTS OH
44137-1003
US

IV. Provider business mailing address

5202 BEECH AVE
MAPLE HEIGHTS OH
44137-1003
US

V. Phone/Fax

Practice location:
  • Phone: 216-470-0895
  • Fax:
Mailing address:
  • Phone: 216-470-0895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EUGENE TEELE
Title or Position: OWNER
Credential:
Phone: 216-470-0895