=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376579532
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST GENERAL HEALTH CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2006
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7265 OLD OAK BLVD
-----------------------------------------------------
City | MIDDLEBURG HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-816-8179
-----------------------------------------------------
Fax | 440-816-8197
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18697 BAGLEY RD
-----------------------------------------------------
City | MIDDLEBURG HTS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44130-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-816-8071
-----------------------------------------------------
Fax | 440-816-6716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | WILLIAM YOUNG JR.
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-816-6701
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------