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General NPI Number Information
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NPI Number | 1225675796
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Entity Type | Organization
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Legal Business Name | BRENDA GLASS MULTIPURPOSE TRAUMA CENTER
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 24885 RANDOLPH RD
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City | BEDFORD HTS
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State | OH
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Zip | 44146-3946
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Country | US
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Telephone | 440-836-2576
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Fax |
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Provider Business Mailing Address
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Address Line | 24885 RANDOLPH RD
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City | BEDFORD HTS
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State | OH
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Zip | 44146-3946
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Country | US
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Telephone | 440-836-2576
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Fax |
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Authorized Official
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Title or Position | FOUNDER & CEO
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Name | BRENDA GLASS
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Credential | LISW-S
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Telephone | 440-836-2576
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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