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1073571360 NPI number — DUAL DIAGNOSIS CENTER OF GREATER CLEVELAND INC

NPI Number: 1073571360
Health Care Provider/Practitioner: DUAL DIAGNOSIS CENTER OF GREATER CLEVELAND INC

Information about “1073571360” NPI (DUAL DIAGNOSIS CENTER OF GREATER CLEVELAND INC) exists in 1073571360 in HTML format HTML  |  1073571360 in plain Text format TXT  |  1073571360 in PDF (Portable Document Format) PDF  |  1073571360 in an XML format XML  formats.

NPI Number : 1073571360 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073571360",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "DUAL DIAGNOSIS CENTER OF GREATER CLEVELAND INC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4486 SILSBY RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CLEVELAND",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "44118-3939",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "216-623-3555",
    "MailingAddressFaxNumber": "216-623-3555",
    "FirstLinePracticeLocationAddress": "2012 W 25TH ST STE 411",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLEVELAND",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "44113-4131",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "216-623-3555",
    "PracticeLocationAddressFaxNumber": "216-623-3555",
    "EnumerationDate": "05/03/2006",
    "LastUpdateDate": "08/22/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "BERES",
    "AuthorizedOfficialFirstName": "BARBARA",
    "AuthorizedOfficialMiddleName": "O",
    "AuthorizedOfficialTitle": "PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "LICDC, LPC",
    "AuthorizedOfficialTelephoneNumber": "216-623-3555",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": "12259, 575",
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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