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General NPI Number Information
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NPI Number | 1093816209
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Entity Type | Organization
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Legal Business Name | BEECH BROOK
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 07/09/2024
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Provider Practice Location Address
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Address Line | 13201 GRANGER RD STE 8
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-1979
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Country | US
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Telephone | 216-831-2255
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Fax | 216-831-0436
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Provider Business Mailing Address
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Address Line | 13201 GRANGER RD STE 8
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City | GARFIELD HEIGHTS
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State | OH
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Zip | 44125-1979
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Country | US
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Telephone | 216-831-2255
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Fax | 216-831-0436
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. THOMAS ROYER
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Credential | MPA
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Telephone | 216-831-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 12773
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 208
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License Number State | OH
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