MEDICARE: FREEDOM YOUTH PROGRAM

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1184380867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM YOUTH PROGRAM

Provider Business Mailing Address
First Line	:	18104 WESTON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1039
Country	:	US
Telephone Number	:	216-712-0056
Fax Number	:

Provider Business Practice Location Address
First Line	:	18104 WESTON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44121-1039
Country	:	US
Telephone Number	:	216-712-0056
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. ZARELL ZACKITOUS PATTON
Credential	:
Telephone Number	:	216-712-0056

Provider Enumeration Date	:	11/16/2021
Last Update Date	:	05/22/2026

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Directions to “FREEDOM YOUTH PROGRAM ” Practice Location

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