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General NPI Number Information
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NPI Number | 1073814679
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Entity Type | Organization
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Legal Business Name | CLEVELAND HEALTH VENTURES, LLC
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Dates
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Enumeration Date | 11/12/2010
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Last Update Date | 06/28/2013
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Provider Practice Location Address
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Address Line | 706 W. KINGS STREET
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-2708
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Country | US
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Telephone | 980-487-5510
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Fax | 980-487-5515
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Provider Business Mailing Address
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Address Line | PO BOX 601884
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City | CHARLOTTE
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State | NC
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Zip | 28260-1884
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Country | US
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Telephone | 980-487-5510
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Fax | 980-487-5515
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | DANIEL WIENS
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Credential |
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Telephone | 704-355-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State |
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