=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265724108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | APPLEWOOD CENTERS INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2011
-----------------------------------------------------
Last Update Date | 05/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15517 LOUIS AVENUE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-402-2071
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15517 LOUIS AVE
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44135-3439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CPST SPECIALIST
-----------------------------------------------------
Name | RISA RUIZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 216-402-2071
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | C.000002
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------