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General NPI Number Information
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NPI Number | 1396117255
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Entity Type | Organization
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Legal Business Name | CLEVELAND URBAN MINORITY ALCOHOLISM DRUG ABUSE OUTREACH PROJECT
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Dates
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Enumeration Date | 10/30/2015
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Last Update Date | 10/30/2015
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Provider Practice Location Address
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Address Line | 1226 E 79TH ST
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City | CLEVELAND
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State | OH
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Zip | 44103-2256
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Country | US
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Telephone | 216-361-1503
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Fax | 216-361-1856
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Provider Business Mailing Address
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Address Line | 1215 E 79TH ST
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City | CLEVELAND
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State | OH
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Zip | 44103-2255
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Country | US
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Telephone | 216-361-2040
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Fax | 216-361-1856
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. JESSICA HORNE
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Credential |
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Telephone | 216-361-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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