Healthcare Provider Details

I. General information

NPI: 1164344560
Provider Name (Legal Business Name): CITIE ONE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4767 NORTHFIELD RD
NORTH RANDALL OH
44128-4509
US

IV. Provider business mailing address

4767 NORTHFIELD RD
NORTH RANDALL OH
44128-4509
US

V. Phone/Fax

Practice location:
  • Phone: 440-263-6120
  • Fax: 216-239-0683
Mailing address:
  • Phone: 216-232-6300
  • Fax: 216-239-0683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TERRELL SCOTT
Title or Position: CORPORATE COMPLIANCE
Credential:
Phone: 419-297-2553