MEDICARE: ST VINCENT CHARITY MEDICAL CENTER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1346949427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST VINCENT CHARITY MEDICAL CENTER

Provider Business Mailing Address
First Line	:	PO BOX 932004
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44193-0007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2475 E 22ND ST FL 4
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44115-3209
Country	:	US
Telephone Number	:	216-363-2570
Fax Number	:

Authorized Official
Title or Position	:	FINANCE DIRECTOR
Name	:	THERESA WRABEL
Credential	:
Telephone Number	:	216-363-3000

Provider Enumeration Date	:	02/28/2023
Last Update Date	:	01/16/2025

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