MEDICARE: GOD'S VISION FOUNDATION, CORP

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	171R00000X	Interpreter
3	174200000X	Meals Provider
4	251V00000X	Voluntary or Charitable Agency
5	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255085569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOD'S VISION FOUNDATION, CORP

Provider Business Mailing Address
First Line	:	5209 HAMM AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1636
Country	:	US
Telephone Number	:	216-512-1463
Fax Number	:	218-215-8593

Provider Business Practice Location Address
First Line	:	5209 HAMM AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44127-1636
Country	:	US
Telephone Number	:	216-512-1463
Fax Number	:	218-215-8593

Authorized Official
Title or Position	:	CASE MANAGER/ CARE CORDINATIOR
Name	:	MRS. MARINELLY CRUZ
Credential	:
Telephone Number	:	216-512-1463

Provider Enumeration Date	:	02/06/2022
Last Update Date	:	02/06/2022

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