MEDICARE: PEOPLE WITH VISIONS GOING PLACES

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	251B00000X	Case Management Agency	050155	OH
2	251V00000X	Voluntary or Charitable Agency	050155	OH
3	302F00000X	Exclusive Provider Organization	050155	OH
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	050155	OH

General Provider Information

NPI Number	:	1184089757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEOPLE WITH VISIONS GOING PLACES

Provider Business Mailing Address
First Line	:	1607 CRAWFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1511
Country	:	US
Telephone Number	:	614-843-5015
Fax Number	:	216-860-4502

Provider Business Practice Location Address
First Line	:	1607 CRAWFORD RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1511
Country	:	US
Telephone Number	:	614-843-5015
Fax Number	:	216-860-4502

Authorized Official
Title or Position	:	CEO
Name	:	MS. ALECEANDRIA DENISE WILLIAMSON
Credential	:	CDCA, BA,MA,QMHS,
Telephone Number	:	614-843-5015

Provider Enumeration Date	:	12/23/2015
Last Update Date	:	12/23/2015

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Directions to “PEOPLE WITH VISIONS GOING PLACES ” Practice Location

Language	Start Address	Practice Location

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