MEDICARE: DUAL DIAGNOSIS CENTER OF GREATER CLEVELAND INC

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	251S00000X	Community/Behavioral Health Agency	12259, 575	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12259	OTHER	OH	MACSIS

General Provider Information

NPI Number	:	1073571360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUAL DIAGNOSIS CENTER OF GREATER CLEVELAND INC

Provider Business Mailing Address
First Line	:	4486 SILSBY RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44118-3939
Country	:	US
Telephone Number	:	216-623-3555
Fax Number	:	216-623-3555

Provider Business Practice Location Address
First Line	:	2012 W 25TH ST STE 411
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44113-4131
Country	:	US
Telephone Number	:	216-623-3555
Fax Number	:	216-623-3555

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BARBARA O BERES
Credential	:	LICDC, LPC
Telephone Number	:	216-623-3555

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	08/22/2020

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Directions to “DUAL DIAGNOSIS CENTER OF GREATER CLEVELAND INC ” Practice Location

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