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General NPI Number Information
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NPI Number | 1962192526
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Entity Type | Organization
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Legal Business Name | TQ RECOVERY HOME
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 05/08/2023
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Provider Practice Location Address
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Address Line | 17325 EUCLID AVE STE 4090
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City | CLEVELAND
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State | OH
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Zip | 44112-1247
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Country | US
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Telephone | 216-465-1064
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Fax | 216-502-2754
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Provider Business Mailing Address
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Address Line | 17325 EUCLID AVE STE 4090
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City | CLEVELAND
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State | OH
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Zip | 44112-1247
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Country | US
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Telephone | 216-465-1064
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Fax | 216-502-2754
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Authorized Official
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Title or Position | OWNER
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Name | SONIA LOCKETT
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Credential |
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Telephone | 440-742-6002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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