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General NPI Number Information
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NPI Number | 1629121025
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Entity Type | Organization
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Legal Business Name | CLEVELAND CHRISTIAN HOME
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 08/10/2016
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Provider Practice Location Address
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Address Line | 11401 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44111-5428
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Country | US
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Telephone | 216-671-0799
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Fax |
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Provider Business Mailing Address
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Address Line | 11401 LORAIN AVE
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City | CLEVELAND
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State | OH
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Zip | 44111-5428
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Country | US
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Telephone | 216-671-0799
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. MIKE J KRAFCIK
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Credential | CPA
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Telephone | 216-688-4130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | OH
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