MEDICARE: JOSEPH'S HOME

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	175T00000X	Peer Specialist
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1336833052
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH'S HOME

Provider Business Mailing Address
First Line	:	2412 COMMUNITY COLLEGE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-3179
Country	:	US
Telephone Number	:	216-363-7803
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 COMMUNITY COLLEGE AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-3179
Country	:	US
Telephone Number	:	216-363-7803
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	BETH GRAHAM
Credential	:
Telephone Number	:	216-363-7803

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	06/12/2023

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Directions to “JOSEPH'S HOME ” Practice Location

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