MEDICARE: JBS LUNCH AND LITERACY OUTREACH CENTER FOR KIDS

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	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1235828724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JBS LUNCH AND LITERACY OUTREACH CENTER FOR KIDS

Provider Business Mailing Address
First Line	:	6624 HARVARD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-4909
Country	:	US
Telephone Number	:	216-355-7140
Fax Number	:

Provider Business Practice Location Address
First Line	:	6624 HARVARD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44105-4909
Country	:	US
Telephone Number	:	216-355-7140
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BARBARA BRADFORD
Credential	:
Telephone Number	:	216-355-7140

Provider Enumeration Date	:	05/02/2023
Last Update Date	:	06/01/2023

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