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General NPI Number Information
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NPI Number | 1790227155
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Entity Type | Organization
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Legal Business Name | COLLABORATION STATION
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 4614 PROSPECT AVE STE 325
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City | CLEVELAND
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State | OH
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Zip | 44103-4377
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Country | US
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Telephone | 216-777-2136
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Fax |
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Provider Business Mailing Address
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Address Line | 4614 PROSPECT AVE SUITE 325
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City | CLEVELAND
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State | OH
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Zip | 44103-4394
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Country | US
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Telephone | 216-777-2136
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Fax | 888-380-3849
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MISS CHERYL J SMITH
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Credential |
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Telephone | 216-777-2136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number | 1310918
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License Number State | OH
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