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General NPI Number Information
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NPI Number | 1003904558
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Entity Type | Organization
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Legal Business Name | HISPANIC URBAN MINORITY ALCHOLISM AND DRUG ABUSE OUTREACH PROGRAM
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3305 W 25TH ST
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City | CLEVELAND
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State | OH
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Zip | 44109-1613
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Country | US
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Telephone | 216-459-1222
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Fax | 216-459-2696
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Provider Business Mailing Address
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Address Line | 3305 W 25TH ST
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City | CLEVELAND
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State | OH
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Zip | 44109-1613
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Country | US
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Telephone | 216-459-1222
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Fax | 216-459-2696
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. CARLOS I. RAMOS
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Credential | PH.D.
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Telephone | 216-459-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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