=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831255835
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLEVELAND FAMILY SERVICES INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/28/2006
-----------------------------------------------------
Last Update Date | 08/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 ROYSTER AVE SUITE 3 & 2B
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28150-6503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-471-2128
-----------------------------------------------------
Fax | 704-471-0989
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 262
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28151-0262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 704-482-6634
-----------------------------------------------------
Fax | 704-482-6635
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. CASSANDRA BELL-GASH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-207-1200
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------