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General NPI Number Information
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NPI Number | 1144646928
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Entity Type | Organization
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Legal Business Name | SACTUARY HEALTH, LLC
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Dates
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Enumeration Date | 03/17/2014
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Last Update Date | 03/17/2014
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Provider Practice Location Address
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Address Line | 2592 W 14TH ST
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City | CLEVELAND
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State | OH
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Zip | 44113-4409
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Country | US
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Telephone | 216-502-2209
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Fax |
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Provider Business Mailing Address
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Address Line | 2592 W 14TH ST
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City | CLEVELAND
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State | OH
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Zip | 44113-4409
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Country | US
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Telephone | 216-502-2209
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL MEMBER
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Name | MR. DAVID J. MENKE
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Credential | LISW, SAP
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Telephone | 216-502-2209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I.1200439
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License Number State | OH
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