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General NPI Number Information
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NPI Number | 1649672106
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Entity Type | Organization
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Legal Business Name | CIELO VITALITY HEALTH & WELLNESS CENTER LLC
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Dates
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Enumeration Date | 09/16/2014
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 36336 VINE ST SUITE 100
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City | WILLOWICK
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State | OH
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Zip | 44095-3164
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Country | US
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Telephone | 216-261-6398
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Fax | 216-261-6398
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Provider Business Mailing Address
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Address Line | 36336 VINE STREET SUITE 100
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City | EASTLAKE
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State | OH
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Zip | 44095
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Country | US
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Telephone | 216-261-6398
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Fax | 216-261-6398
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Authorized Official
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Title or Position | VP. OF OPERATIONS
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Name | DONAVON HUFF
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Credential | M.S.P.T.
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Telephone | 216-261-6398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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