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General NPI Number Information
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NPI Number | 1174401970
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Entity Type | Organization
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Legal Business Name | KINGDOM BUILDERS TRANSITIONAL HOUSING PROGRAM OF OHIO
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 3043 SUPERIOR AVE STE 202
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City | CLEVELAND
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State | OH
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Zip | 44114-4349
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Country | US
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Telephone | 330-805-6337
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Fax |
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Provider Business Mailing Address
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Address Line | 3659 GREEN RD STE 220
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City | BEACHWOOD
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State | OH
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Zip | 44122-5715
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Country | US
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Telephone | 330-805-6337
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KERRIE JAMES-HUNTER
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Credential |
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Telephone | 330-805-6337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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