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General NPI Number Information
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NPI Number | 1396070652
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Entity Type | Organization
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Legal Business Name | CLEVELAND HEALTH VENTURES LLC
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Dates
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Enumeration Date | 10/05/2009
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Last Update Date | 06/28/2010
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Provider Practice Location Address
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Address Line | 502 W KING ST SUITE B
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City | KINGS MOUNTAIN
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State | NC
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Zip | 28086-3362
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Country | US
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Telephone | 980-487-2299
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Fax | 704-730-8262
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Provider Business Mailing Address
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Address Line | PO BOX 602341
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City | CHARLOTTE
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State | NC
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Zip | 28260-2341
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MR. DANIEL WIENS
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Credential |
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Telephone | 704-355-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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