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General NPI Number Information
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NPI Number | 1194095893
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Entity Type | Organization
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Legal Business Name | CLEVELAND JUVENILE JUSTICE AND DELINQUENCY PREVENTIN CENTER
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Dates
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Enumeration Date | 01/11/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 3385 EAST 147TH STREET
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City | CLEVELAND
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State | OH
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Zip | 44120
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Country | US
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Telephone | 216-754-0615
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Fax |
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Provider Business Mailing Address
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Address Line | 3385 E 147TH ST
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City | CLEVELAND
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State | OH
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Zip | 44120-4133
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Country | US
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Telephone | 216-754-0615
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CALVIN DRAKE
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Credential | OWNER,
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Telephone | 216-754-0615
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | EXEMPTION
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 3245S0500X
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Taxonomy Name | Children's Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | EXEMPTION
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License Number State | OH
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Taxonomy #5
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | EXEMPTION/ CLERGY
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License Number State | OH
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