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General NPI Number Information
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NPI Number | 1720278112
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Entity Type | Organization
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Legal Business Name | INNER CITY LIVING INC
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Dates
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Enumeration Date | 07/31/2007
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Last Update Date | 09/15/2024
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Provider Practice Location Address
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Address Line | 10323 SLADDEN AVE
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City | CLEVELAND
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State | OH
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Zip | 44125-1560
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Country | US
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Telephone | 216-288-4997
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Fax |
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Provider Business Mailing Address
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Address Line | 10323 SLADDEN AVE
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City | CLEVELAND
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State | OH
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Zip | 44125-1560
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Country | US
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Telephone | 216-288-4997
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Fax | 216-650-8568
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Authorized Official
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Title or Position | PRESIDENT
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Name | LANIECE DAVIS
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Credential |
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Telephone | 216-288-4997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 2711775
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 2711775
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License Number State | OH
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