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General NPI Number Information
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NPI Number | 1740345339
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Entity Type | Organization
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Legal Business Name | CITY OF CLEVELAND
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 10/16/2008
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Provider Practice Location Address
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Address Line | 11100 SAINT CLAIR AVE J. GLEN SMITH HEALTH CENTER
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City | CLEVELAND
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State | OH
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Zip | 44108-1943
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Country | US
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Telephone | 216-664-3891
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Fax |
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Provider Business Mailing Address
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Address Line | 1925 SAINT CLAIR AVE NE CLEVELAND DEPARTMENT OF PUBLIC HEALTH
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City | CLEVELAND
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State | OH
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Zip | 44114-2028
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Country | US
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Telephone | 216-664-3920
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, CDPH
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Name | MATT CARROLL
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Credential |
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Telephone | 216-664-6790
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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 | 1073
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License Number State | OH
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