=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043031982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE MARBELL FOUNDATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2024
-----------------------------------------------------
Last Update Date | 10/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6074 TURNEY RD
-----------------------------------------------------
City | GARFIELD HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44125-4520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-372-2299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6815 EUCLID AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44103-3915
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-372-2299
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR/DOO
-----------------------------------------------------
Name | PATRICIA BELL
-----------------------------------------------------
Credential | LISW
-----------------------------------------------------
Telephone | 216-372-2299
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 373H00000X
-----------------------------------------------------
Taxonomy Name | Day Training/Habilitation Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------