MEDICARE: L'ARCHE 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		OH

General Provider Information

NPI Number	:	1114080959
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L'ARCHE CLEVELAND, INC.

Provider Business Mailing Address
First Line	:	PO BOX 20450
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-0450
Country	:	US
Telephone Number	:	216-721-2614
Fax Number	:	216-229-2311

Provider Business Practice Location Address
First Line	:	11811 SHAKER BLVD
Second Line	:	SUITE 320
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1931
Country	:	US
Telephone Number	:	216-721-2614
Fax Number	:	216-229-2311

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	REBECCA BRADY
Credential	:	RN
Telephone Number	:	216-721-2614

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	08/22/2020

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