MEDICARE: CLEVELAND VENTURE GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	033-R-0099	GA

General Provider Information

NPI Number	:	1063731438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEVELAND VENTURE GROUP

Provider Business Mailing Address
First Line	:	3020 ROSWELL RD
Second Line	:	STE. 200
City	:	MARIETTA
State	:	GA
Zip	:	30062-4996
Country	:	US
Telephone Number	:	678-819-3915
Fax Number	:	770-565-0490

Provider Business Practice Location Address
First Line	:	3020 ROSWELL RD
Second Line	:	STE. 200
City	:	MARIETTA
State	:	GA
Zip	:	30062-4996
Country	:	US
Telephone Number	:	678-819-3915
Fax Number	:	770-565-0490

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MS. ROBIN CLEVELAND
Credential	:
Telephone Number	:	678-819-3915

Provider Enumeration Date	:	05/25/2010
Last Update Date	:	05/25/2010

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