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General NPI Number Information
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NPI Number | 1871029629
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Entity Type | Organization
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Legal Business Name | PROVIDENCE HOUSE
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 2050 W 32ND ST
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City | CLEVELAND
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State | OH
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Zip | 44113-4018
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Country | US
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Telephone | 216-651-5982
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Fax |
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Provider Business Mailing Address
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Address Line | 2050 W 32ND ST
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City | CLEVELAND
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State | OH
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Zip | 44113-4018
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Country | US
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Telephone | 216-651-5982
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | NATALIE LEEK
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Credential |
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Telephone | 216-651-5982
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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 |
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 251V00000X
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Taxonomy Name | Voluntary or Charitable Agency
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License Number |
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License Number State |
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