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NPI Code Detail

MEDICARE: MIKLAT RECOVERY

MEDICARE: MIKLAT RECOVERY
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
1261QM0850XAdult Mental Health Clinic/Center

General Provider Information

NPI Number : 1376316547
Entity Type Code : Organization
Provider Name (Legal Business Name) : MIKLAT RECOVERY
Provider Business Mailing Address
First Line : 23412 COMMERCE PARK
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5813
Country : US
Telephone Number : 216-400-6640
Fax Number : 216-920-6215
Provider Business Practice Location Address
First Line : 23412 COMMERCE PARK
Second Line :
City : BEACHWOOD
State : OH
Zip : 44122-5813
Country : US
Telephone Number : 216-400-6640
Fax Number : 216-920-6215
Authorized Official
Title or Position : CEO
Name : AHARON FERGUSSON
Credential :
Telephone Number : 216-400-6640
Provider Enumeration Date : 10/31/2023
Last Update Date : 10/31/2023

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Directions to “MIKLAT RECOVERY ” Practice Location

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